Provider Demographics
NPI:1619223948
Name:WILDER, RHONDA LYNN (COLON HYGIENIST)
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:LYNN
Last Name:WILDER
Suffix:
Gender:F
Credentials:COLON HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-6340
Mailing Address - Country:US
Mailing Address - Phone:228-497-2426
Mailing Address - Fax:228-497-2821
Practice Address - Street 1:313 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553-6340
Practice Address - Country:US
Practice Address - Phone:228-497-2426
Practice Address - Fax:228-497-2821
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF-RW2112002175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath