Provider Demographics
NPI:1356639918
Name:WILDER, LILLIAN MARGARET (CNIM)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:MARGARET
Last Name:WILDER
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:WINNIE
Mailing Address - State:TX
Mailing Address - Zip Code:77665-2359
Mailing Address - Country:US
Mailing Address - Phone:713-560-5386
Mailing Address - Fax:
Practice Address - Street 1:2150 TOWN SQUARE PLACE
Practice Address - Street 2:SUITE 290
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-1643
Practice Address - Country:US
Practice Address - Phone:281-768-6730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1648246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic