Individual
VICKI A WYSONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2333 E COUNTY ROAD 375 S, CONNERSVILLE, IN 47331-9434
(765) 825-6234
Mailing address
2333 E. COUNTY RD. 375 S., CONNERSVILLE, IN 47331-1157
(765) 825-6234
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71000824A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000699327
ANTHEM
IN
05
—
200506950
—
IN
Enumeration date
03/15/2006
Last updated
01/14/2016
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