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General NPI Number Information
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NPI Number | 1205659323
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Entity Type | Individual
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Provider Name | NICOLE M WILSON APN
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Gender | Female
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 429 E VERMONT ST STE 110
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-3685
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Country | US
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Telephone | 317-559-0950
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Fax |
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Provider Business Mailing Address
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Address Line | 429 E VERMONT ST STE 110
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-3685
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Country | US
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Telephone | 317-559-0950
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 209.030991
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71016247A
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License Number State | IN
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