Individual
CACIA L WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3750 LANDMARK DR STE A, LAFAYETTE, IN 47905-6652
(765) 448-4511
(765) 447-7312
Mailing address
3750 LANDMARK DR STE A, LAFAYETTE, IN 47905-6652
(765) 448-4511
(765) 447-7312
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28195527A
IN
363LF0000X
Family Nurse Practitioner
Primary
71005451A
IN
Other
Enumeration date
04/02/2015
Last updated
03/29/2021
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