Provider Demographics
NPI:1770577322
Name:WILDER, BERNICE JOANN (DNP, ARNP, BC)
Entity type:Individual
Prefix:DR
First Name:BERNICE
Middle Name:JOANN
Last Name:WILDER
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Gender:F
Credentials:DNP, ARNP, BC
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Mailing Address - Street 1:101 BODIN CIRCLE
Mailing Address - Street 2:DAVID GRANT MEDICAL CENTER
Mailing Address - City:TRAVIS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:94535
Mailing Address - Country:US
Mailing Address - Phone:707-423-5174
Mailing Address - Fax:707-423-5144
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER
Practice Address - Street 2:9040 JACKSON AVE
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98438-1336
Practice Address - Country:US
Practice Address - Phone:253-982-3685
Practice Address - Fax:253-982-9037
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2019-05-03
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Provider Licenses
StateLicense IDTaxonomies
WARN00096394163WP0809X
WAAP0003838363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult