Healthcare Provider Details

I. General information

NPI: 1669697033
Provider Name (Legal Business Name): ESTHER L. WILSON RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 05/02/2023
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 S BLOOMINGTON ST
GREENCASTLE IN
46135-2212
US

IV. Provider business mailing address

1542 S BLOOMINGTON ST
GREENCASTLE IN
46135-2212
US

V. Phone/Fax

Practice location:
  • Phone: 765-301-7380
  • Fax:
Mailing address:
  • Phone: 765-301-7449
  • Fax: 765-301-7481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71000122A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: