Individual
INA L WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
550 UNIVERSITY BLVD, INDIANAPOLIS, IN 46202-5149
(317) 944-5000
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
28151231A
IN
363L00000X
Nurse Practitioner
71002303A
IN
363LA2200X
Adult Health Nurse Practitioner
Primary
71002303A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200841930
—
IN
01
—
264430G07
MEDICARE PTAN
IN
Enumeration date
10/01/2006
Last updated
02/06/2024
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