Wilson, Mandy Corinne

Wilson, Mandy Corinne is an individual health care provider with primary practice located at 1373 E State Road 62 , Madison IN 47250-7328. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Wilson, Mandy Corinne can be contacted via phone (812) 801-0868.

Contact Information

Primary practice address
1373 E State Road 62 Madison IN 47250-7328
Phone: (812) 801-0868
Fax: (812) 801-8070
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 71003745A Indiana

Profile Details

NPI number 1033494794
LBN Legal business name Wilson, Mandy Corinne
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 13th, 2011
Last updated Mar 11th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1033494794 NPPES
Kentucky MEDICAID 7100314430
Kentucky Other 9610899
Kentucky MEDICAID 201085400
Kentucky Other 897443

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