MEDICARE: DAMEA WILBURN

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
1	253Z00000X	In Home Supportive Care Agency	250189801	IN

General Provider Information

NPI Number	:	1790643443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAMEA WILBURN

Provider Business Mailing Address
First Line	:	2231 VALLEY POINT PL APT 1526
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46217-2256
Country	:	US
Telephone Number	:	463-256-6741
Fax Number	:

Provider Business Practice Location Address
First Line	:	2840 N HIGH SCHOOL RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-4724
Country	:	US
Telephone Number	:	463-256-6741
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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