Provider Demographics
NPI:1932854908
Name:THE DUFF WILDER GROUP, LLC
Entity Type:Organization
Organization Name:THE DUFF WILDER GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONDRA
Authorized Official - Middle Name:DUFF
Authorized Official - Last Name:WILDER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC; PMHNP-BC
Authorized Official - Phone:205-399-7795
Mailing Address - Street 1:PO BOX 804
Mailing Address - Street 2:
Mailing Address - City:GORDO
Mailing Address - State:AL
Mailing Address - Zip Code:35466-0804
Mailing Address - Country:US
Mailing Address - Phone:205-399-7795
Mailing Address - Fax:
Practice Address - Street 1:208 10TH ST NE
Practice Address - Street 2:
Practice Address - City:GORDO
Practice Address - State:AL
Practice Address - Zip Code:35466-2754
Practice Address - Country:US
Practice Address - Phone:205-399-7795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-17
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty