Provider Demographics
NPI:1689805061
Name:WILSON, FREDERICKA ALONA (DPM, MPH)
Entity Type:Individual
Prefix:DR
First Name:FREDERICKA
Middle Name:ALONA
Last Name:WILSON
Suffix:
Gender:F
Credentials:DPM, MPH
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8206 ROCKVILLE RD # 192
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-3113
Mailing Address - Country:US
Mailing Address - Phone:317-872-3338
Mailing Address - Fax:317-872-3339
Practice Address - Street 1:4010 W 86TH ST STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1779
Practice Address - Country:US
Practice Address - Phone:317-872-3338
Practice Address - Fax:317-872-3339
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN07001094A213ES0131X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery