| NPI | 1033782156 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL DAWN WILES Owner., Authorized Official 317-501-8496 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2021-07-19 |
| Last Update Date | 2021-07-19 |