Provider Demographics
NPI:1336479161
Name:WILSON, STEPHANIE S (NP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:S
Last Name:WILSON
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:9615 E 148TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4360
Mailing Address - Country:US
Mailing Address - Phone:317-587-0500
Mailing Address - Fax:317-674-0060
Practice Address - Street 1:2009 BROWN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-4216
Practice Address - Country:US
Practice Address - Phone:317-574-1254
Practice Address - Fax:317-674-0060
Is Sole Proprietor?:No
Enumeration Date:2009-12-29
Last Update Date:2015-04-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN28144253A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner