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Individual

DR. JANE ELLEN WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
5550 S EAST ST, STE.I, INDIANAPOLIS, IN 46227-1979
(317) 780-4080
(317) 780-4088
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01047151A
IN
2080A0000X
Pediatric Adolescent Medicine Physician
01047151
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000507395
ANTHEM
IN
05
200181770
IN
Enumeration date
06/09/2005
Last updated
02/02/2022
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