Individual
LISA E WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3387 S US HIGHWAY 41, TERRE HAUTE, IN 47802-4188
(812) 232-5532
(812) 232-2574
Mailing address
3387 S US HIGHWAY 41 STE A, TERRE HAUTE, IN 47802-4188
(812) 232-5532
(812) 232-2574
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
28176662A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000863791
ANTHEM
IN
05
—
201216600
—
IN
Enumeration date
03/11/2014
Last updated
03/09/2023
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