Provider Demographics
NPI:1902923956
Name:GOLDEN, WILLIE B JR (CNA)
Entity Type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:B
Last Name:GOLDEN
Suffix:JR
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5706 RENN LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-2300
Mailing Address - Country:US
Mailing Address - Phone:317-387-1363
Mailing Address - Fax:
Practice Address - Street 1:3011 N FRANKLIN RD
Practice Address - Street 2:SMC CORPORATION OF AMERICA
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-6308
Practice Address - Country:US
Practice Address - Phone:317-603-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN49019812782376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide