Individual
DOMANIC WILTERMOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
915 SAGAMORE PKWY W, WEST LAFAYETTE, IN 47906-1443
(765) 463-2424
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28225056A
IN
363LF0000X
Family Nurse Practitioner
Primary
71014180A
IN
Other
Enumeration date
06/14/2023
Last updated
09/05/2023
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