Individual
BRENDA S. WILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7900 W JEFFERSON BLVD, SUITE 201, FORT WAYNE, IN 46804-4128
(260) 432-2297
(260) 969-7266
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 479-3514
(260) 479-3520
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71002581A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200888290
—
IN
05
—
3040613
—
OH
Enumeration date
02/19/2008
Last updated
09/30/2020
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