Provider Demographics
NPI:1801807060
Name:WILSON, DAYNA L (NP)
Entity type:Individual
Prefix:MS
First Name:DAYNA
Middle Name:L
Last Name:WILSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:DAYNA
Other - Middle Name:L
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1260 INNOVATION PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-3602
Mailing Address - Country:US
Mailing Address - Phone:317-884-5200
Mailing Address - Fax:317-884-5360
Practice Address - Street 1:1260 INNOVATION PKWY STE 100
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-3602
Practice Address - Country:US
Practice Address - Phone:317-884-5200
Practice Address - Fax:317-884-5360
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28144894163W00000X
IN71002378363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71002378OtherNP LICENSE
IN28144894OtherRN LICENSE