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NPI Code Detail

MEDICARE: LYNDSEY WILSON

MEDICARE: LYNDSEY WILSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner71006887AIN

General Provider Information

NPI Number : 1417495672
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNDSEY WILSON
Provider Business Mailing Address
First Line : PO BOX 1329
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47402-1329
Country : US
Telephone Number : 812-829-2237
Fax Number : 812-829-6342
Provider Business Practice Location Address
First Line : 9 N CRANE AVE
Second Line :
City : SPENCER
State : IN
Zip : 47460-1507
Country : US
Telephone Number : 812-829-2237
Fax Number : 812-829-6342
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2017
Last Update Date : 12/28/2020

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Directions to “ LYNDSEY WILSON ” Practice Location

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