Provider Demographics
NPI:1740981588
Name:WILDER, DEBORAH CHARITA
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:CHARITA
Last Name:WILDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 MISSISSIPPI AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-4135
Mailing Address - Country:US
Mailing Address - Phone:240-510-7349
Mailing Address - Fax:
Practice Address - Street 1:702 MISSISSIPPI AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4135
Practice Address - Country:US
Practice Address - Phone:240-510-7349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator