Individual
MRS. DOMONIQUE N WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
10549 ONTARIO DR, CROWN POINT, IN 46307-9371
(928) 278-0027
Mailing address
10549 ONTARIO DR, CROWN POINT, IN 46307-9371
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
28261922A
IN
Other
Enumeration date
12/09/2025
Last updated
12/09/2025
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