| Glorious Latric Wilson-reynolds, CPNP | |
|
1509 State St, La Porte, IN 46350-3115 | |
| (219) 324-3431 | |
| (219) 362-3802 |
| Full Name | Glorious Latric Wilson-reynolds |
|---|---|
| Gender | Female |
| Speciality | Nurse Practitioner - Pediatrics |
| Location | 1509 State St, La Porte, Indiana |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376898320 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LP0200X | Nurse Practitioner - Pediatrics | 209008737 (Illinois) | Secondary |
| 363LP0200X | Nurse Practitioner - Pediatrics | 71005286A (Indiana) | Primary |
| Entity Name | Indiana University Health La Porte Physicians Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1760593776 PECOS PAC ID: 0345147963 Enrollment ID: O20031212000670 |
| Entity Name | La Porte Clinic Company Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1568829224 PECOS PAC ID: 0446558357 Enrollment ID: O20160408001751 |
| Mailing Address | Practice Location Address |
|---|---|
| Glorious Latric Wilson-reynolds, CPNP 2022 Kelle Dr, Chesterton, IN 46304-8708 Ph: (219) 326-2312 | Glorious Latric Wilson-reynolds, CPNP 1509 State St, La Porte, IN 46350-3115 Ph: (219) 324-3431 |
Mrs. Jennifer Campbell, CPNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1509 State Street, La Porte, IN 46350 Phone: 219-324-3431 Fax: 219-362-3802 | |
Tami Clinkenbeard, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 401 Newporte Blvd, La Porte, IN 46350 Phone: 219-326-1775 Fax: 219-326-1951 | |
Kimberly Minich, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 602 F St, La Porte, IN 46350 Phone: 219-324-1377 | |
April Donald, FNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 204 Legacy Plz W, La Porte, IN 46350 Phone: 219-476-7246 | |
Mrs. Tina Marie Pierce, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 809 Jefferson Ave, La Porte, IN 46350 Phone: 219-878-5645 | |
Sandra R Gates-manna, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1509 State St, La Porte, IN 46350 Phone: 219-325-5434 Fax: 219-325-7655 | |
Diane E Spoljoric, FNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 6916 W Johnson Rd, La Porte, IN 46350 Phone: 219-326-7337 Fax: 219-814-4228 |