Provider Demographics
NPI:1194865386
Name:SMITH-WILSON, BELINDA R (NP)
Entity type:Individual
Prefix:
First Name:BELINDA
Middle Name:R
Last Name:SMITH-WILSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5717 S ANTHONY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46806-3386
Mailing Address - Country:US
Mailing Address - Phone:260-447-8982
Mailing Address - Fax:260-447-4483
Practice Address - Street 1:3010 E STATE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4700
Practice Address - Country:US
Practice Address - Phone:260-496-9940
Practice Address - Fax:260-496-8971
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71002338A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily