Provider Demographics
NPI:1053634428
Name:WILDAY, AUBREY ANN
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:ANN
Last Name:WILDAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 EARL DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-4238
Mailing Address - Country:US
Mailing Address - Phone:585-506-8273
Mailing Address - Fax:
Practice Address - Street 1:6620 E BETHANY LEROY RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:NY
Practice Address - Zip Code:14143-9565
Practice Address - Country:US
Practice Address - Phone:585-768-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297025164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse