Provider Demographics
NPI:1356552061
Name:WILDE, HEATHER AURA (NMD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:AURA
Last Name:WILDE
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5635 N SCOTTSDALE RD STE 170-112
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-5937
Mailing Address - Country:US
Mailing Address - Phone:773-609-4533
Mailing Address - Fax:
Practice Address - Street 1:5635 N SCOTTSDALE RD STE 170-112
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-5937
Practice Address - Country:US
Practice Address - Phone:773-609-4533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND415175F00000X
AZ06-942175F00000X
MTAHC-NAT-LIC-2593175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath