Healthcare Provider Details

I. General information

NPI: 1023723756
Provider Name (Legal Business Name): ELIZABETH WILSON APRN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 N PENNSYLVANIA ST
INDIANAPOLIS IN
46204-1020
US

IV. Provider business mailing address

927 N PENNSYLVANIA ST
INDIANAPOLIS IN
46204-1020
US

V. Phone/Fax

Practice location:
  • Phone: 833-659-4357
  • Fax:
Mailing address:
  • Phone: 833-659-4357
  • Fax: 317-463-8226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71016214A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71016214A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28202663A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: