GLORIOUS LATRIC WILSON-REYNOLDS

LA PORTE, IN
NPI1376898320
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363LP0200X Nurse Practitioner, Pediatrics
(Licence: IN  71005286A)
Additional Taxonomies363LP0200X Nurse Practitioner, Pediatrics
(Licence: IL  209008737)
Enumeration Date2012-07-16
Last Update Date2020-09-28
Business Address
GLORIOUS LATRIC WILSON-REYNOLDS CPNP
1509 STATE ST
LA PORTE, IN 46350-3115
Phone number: 219-324-3431
Mailing Address
GLORIOUS LATRIC WILSON-REYNOLDS CPNP
2022 KELLE DR
CHESTERTON, IN 46304-8708
Phone number: 219-326-2312