Healthcare Provider Details

I. General information

NPI: 1356346324
Provider Name (Legal Business Name): MARY ANN WILSBACHER RN, FNP, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 03/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 N 1ST AVE STE E
EVANSVILLE IN
47710-3326
US

IV. Provider business mailing address

PO BOX 359
EVANSVILLE IN
47703-0359
US

V. Phone/Fax

Practice location:
  • Phone: 812-425-3362
  • Fax: 812-428-8412
Mailing address:
  • Phone: 812-485-1220
  • Fax: 812-485-8544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71001653A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: