Provider Demographics
NPI:1497348171
Name:WILDEY, ALLISON MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARIE
Last Name:WILDEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26206 W 12 MILE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1799
Mailing Address - Country:US
Mailing Address - Phone:248-200-3715
Mailing Address - Fax:
Practice Address - Street 1:26206 W 12 MILE RD STE 105
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1799
Practice Address - Country:US
Practice Address - Phone:248-200-3717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-14
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704360424163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse