Provider Demographics
NPI:1003198466
Name:WILHELM, ANASTASIA
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:WILHELM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANASTASIA
Other - Middle Name:
Other - Last Name:WILHELM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:2000 ALAMEDA DE LAS PULGAS
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1269
Mailing Address - Country:US
Mailing Address - Phone:650-573-2959
Mailing Address - Fax:
Practice Address - Street 1:2000 ALAMEDA DE LAS PULGAS
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1269
Practice Address - Country:US
Practice Address - Phone:650-573-2959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA425168171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator