Provider Demographics
NPI:1528388840
Name:WILDER, WENDY FRANCES (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:FRANCES
Last Name:WILDER
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Gender:F
Credentials:RN, BSN
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Other - First Name:
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Mailing Address - Street 1:575 S MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1778
Mailing Address - Country:US
Mailing Address - Phone:734-451-7800
Mailing Address - Fax:734-451-5410
Practice Address - Street 1:575 S MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1778
Practice Address - Country:US
Practice Address - Phone:734-451-7800
Practice Address - Fax:734-451-5410
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704224357101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)