Provider Demographics
NPI:1043966658
Name:WILCHER, CLYETTE (NP)
Entity Type:Individual
Prefix:
First Name:CLYETTE
Middle Name:
Last Name:WILCHER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 W AVENUE K APT 211
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-5229
Mailing Address - Country:US
Mailing Address - Phone:661-317-2047
Mailing Address - Fax:
Practice Address - Street 1:1300 NORTH VERMONT HOLLYWOOD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-9002
Practice Address - Country:US
Practice Address - Phone:323-522-6857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA682207R00000X
CA95020525363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty