Provider Demographics
NPI:1689921454
Name:WILDOVE, DONA RUTH (MS ED,)
Entity Type:Individual
Prefix:MS
First Name:DONA
Middle Name:RUTH
Last Name:WILDOVE
Suffix:
Gender:F
Credentials:MS ED,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 WASHINGTON AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-5390
Mailing Address - Country:US
Mailing Address - Phone:518-339-4760
Mailing Address - Fax:518-464-1469
Practice Address - Street 1:230 WASHINGTON AVENUE EXT
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-5390
Practice Address - Country:US
Practice Address - Phone:518-339-4760
Practice Address - Fax:518-464-1469
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0068174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist