Individual provider · Type 1 NPI

Glorious Latric Wilson-Reynolds, CPNP

Pediatric Nurse Practitioner · La Porte, IN

NPI number 1376898320 Active

Practice location

1509 State St
La Porte, IN 46350-3115

Fax (219) 362-3802

Mailing address

2022 Kelle Dr
Chesterton, IN 46304-8708

Specialties and licenses

TaxonomyCodeLicense
Pediatric Nurse Practitioner 363LP0200X209008737 (IL)
Pediatric Nurse Practitioner Primary 363LP0200X71005286A (IN)

Pediatric Nurse Practitioner: Definition to come...

16 other providers at this address

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About NPI 1376898320

Glorious Latric Wilson-Reynolds, CPNP's National Provider Identifier is 1376898320, issued on Jul 16, 2012. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in La Porte, IN. The record was last updated on Sep 28, 2020.