Provider Information for 1902308166
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MARIA ANTIONETTA WILSON
Sex: Female
NPI: 1902308166
Last Updated: 2021-09-30
Certification Date: 2021-09-30
Certification Date: 2021-09-30
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1902308166 | ||||||||||||
| Enumeration Date | 2018-03-05 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 8401 HARCOURT RD INDIANAPOLIS, IN 46260-2036 United States Phone: | Fax: | ||||||||||||
| Primary Practice Address | 101 S WASHINGTON ST MARION, IN 46952-3867 United States Phone: 765-662-9971 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 8401 HARCOURT RD | ||||||||||||
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