Individual
DANIELLE K WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
100 NAVARRE PL STE 4440, SOUTH BEND, IN 46601-1171
(574) 647-3725
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-3725
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10005132A
IN
363A00000X
Physician Assistant
Primary
—
—
363AS0400X
Surgical Physician Assistant
0110-007882
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300125681
—
IN
Enumeration date
10/31/2019
Last updated
02/03/2026
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