Provider Demographics
NPI:1356346324
Name:WILSBACHER, MARY ANN (RN, FNP, WHNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:WILSBACHER
Suffix:
Gender:F
Credentials:RN, FNP, WHNP
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Mailing Address - Street 1:PO BOX 359
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47703-0359
Mailing Address - Country:US
Mailing Address - Phone:812-485-1220
Mailing Address - Fax:812-485-8544
Practice Address - Street 1:3838 N 1ST AVE
Practice Address - Street 2:STE E
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-3326
Practice Address - Country:US
Practice Address - Phone:812-425-3362
Practice Address - Fax:812-428-8412
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2015-03-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71001653A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q03917Medicare UPIN