Provider Demographics
NPI:1235660929
Name:WILDES, MEGAN GRACE (ARNP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:GRACE
Last Name:WILDES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2607 S SOUTHEAST BLVD
Mailing Address - Street 2:BLDG. A
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4942
Mailing Address - Country:US
Mailing Address - Phone:509-464-6208
Mailing Address - Fax:888-316-1928
Practice Address - Street 1:2607 S SOUTHEAST BLVD
Practice Address - Street 2:BLDG. A
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4942
Practice Address - Country:US
Practice Address - Phone:509-464-6208
Practice Address - Fax:888-316-1928
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60733408363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner