Provider Demographics
NPI:1659023539
Name:WILDER, CATHERINE ROSE (RN)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ROSE
Last Name:WILDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:ROSE
Other - Last Name:MCPHERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:101 CLAYTON SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-2847
Mailing Address - Country:US
Mailing Address - Phone:901-654-5664
Mailing Address - Fax:
Practice Address - Street 1:101 CLAYTON SCOTT ST
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-2847
Practice Address - Country:US
Practice Address - Phone:901-654-5664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-22
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN307315163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse