Healthcare Provider Details

I. General information

NPI: 1457056301
Provider Name (Legal Business Name): VICTORIA R DENZ-WILSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 W TIPTON ST
SEYMOUR IN
47274-2363
US

IV. Provider business mailing address

411 W TIPTON ST
SEYMOUR IN
47274-2363
US

V. Phone/Fax

Practice location:
  • Phone: 812-523-5862
  • Fax: 812-523-4753
Mailing address:
  • Phone: 812-523-5862
  • Fax: 812-523-4753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02009124A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: