Individual
JANINE ELISE WALLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
533 E COUNTY LINE RD, SUITE 201, GREENWOOD, IN 46143-1073
(317) 706-7246
(317) 706-3417
Mailing address
8805 N MERIDIAN ST, INDIANAPOLIS, IN 46260-2760
(317) 706-7246
(317) 706-3419
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
71001045A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200368100
—
IN
Enumeration date
09/16/2006
Last updated
09/07/2016
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