Provider Demographics
NPI:1255404455
Name:WILSON, AMY ELIZABETH (NP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:ELIZABETH
Last Name:WILSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:112 HOSPITAL LN STE 302
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-1998
Mailing Address - Country:US
Mailing Address - Phone:317-272-7510
Mailing Address - Fax:317-272-7514
Practice Address - Street 1:112 HOSPITAL LN STE 302
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1998
Practice Address - Country:US
Practice Address - Phone:317-272-7510
Practice Address - Fax:317-272-7514
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28081642A363LX0001X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology