Provider Demographics
NPI:1740911395
Name:WILTERMOOD, WENDY (CAREGIVER)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:
Last Name:WILTERMOOD
Suffix:
Gender:F
Credentials:CAREGIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7136 ACHESON ROAD
Mailing Address - Street 2:
Mailing Address - City:BUSHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62681
Mailing Address - Country:US
Mailing Address - Phone:217-719-0853
Mailing Address - Fax:
Practice Address - Street 1:3 GULF VIEW ACRES
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62681
Practice Address - Country:US
Practice Address - Phone:319-338-0581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider