Provider Demographics
NPI:1558554774
Name:WILDER, MELODY J (RN)
Entity Type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:J
Last Name:WILDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WINDSOR ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-4127
Mailing Address - Country:US
Mailing Address - Phone:978-373-2694
Mailing Address - Fax:
Practice Address - Street 1:4 WINDSOR ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-4127
Practice Address - Country:US
Practice Address - Phone:978-373-2694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA203308163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse