Provider Demographics
NPI:1760248983
Name:WILDES, WENDY ANN (PMHNP)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ANN
Last Name:WILDES
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 PATRICIA CT
Mailing Address - Street 2:
Mailing Address - City:GALES FERRY
Mailing Address - State:CT
Mailing Address - Zip Code:06335-1826
Mailing Address - Country:US
Mailing Address - Phone:860-287-6162
Mailing Address - Fax:
Practice Address - Street 1:403 N FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-4364
Practice Address - Country:US
Practice Address - Phone:860-444-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT64612163WS0200X
CT13092363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WS0200XNursing Service ProvidersRegistered NurseSchool