Provider Demographics
NPI:1588364723
Name:WILSON, BIANCA ARDENIA (CD(DONA))
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:ARDENIA
Last Name:WILSON
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:BIANCA
Other - Middle Name:A
Other - Last Name:GILLESPIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CD(DONA)
Mailing Address - Street 1:7922 BRACKEN PKWY
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6852
Mailing Address - Country:US
Mailing Address - Phone:219-334-9075
Mailing Address - Fax:
Practice Address - Street 1:1201 S MAIN ST
Practice Address - Street 2:FRANCISCAN CROWN POINT HOSPITAL
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-4630
Practice Address - Country:US
Practice Address - Phone:219-757-6330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN13684374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2Medicaid