Provider Demographics
NPI:1952557563
Name:PAULA F WILDER
Entity Type:Organization
Organization Name:PAULA F WILDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:F
Authorized Official - Last Name:WILDER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:901-857-8925
Mailing Address - Street 1:5547 GLENWILD AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-6011
Mailing Address - Country:US
Mailing Address - Phone:901-857-8925
Mailing Address - Fax:
Practice Address - Street 1:5547 GLENWILD AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-6011
Practice Address - Country:US
Practice Address - Phone:901-857-8925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000006154163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP16098Medicare UPIN