Provider Demographics
NPI:1821636903
Name:WILDER, EMMA PASCAL (ND)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:PASCAL
Last Name:WILDER
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 MOUNTAIN VIEW DR STE 103
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:VT
Mailing Address - Zip Code:05446-8081
Mailing Address - Country:US
Mailing Address - Phone:802-860-3366
Mailing Address - Fax:
Practice Address - Street 1:302 MOUNTAIN VIEW DR STE 103
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-8081
Practice Address - Country:US
Practice Address - Phone:802-860-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000193175F00000X
VT099.0134192175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath