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NPI Code Detail

MEDICARE: MARY ANN WILDER RNC, MSN, C-APN

MEDICARE: MARY ANN WILDER RNC, MSN, C-APN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WN0002XNeonatal Intensive Care Registered NurseAPN000572NV
2363LN0000XNeonatal Nurse PractitionerAPN000572NV

General Provider Information

NPI Number : 1265496509
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ANN WILDER RNC, MSN, C-APN
Provider Business Mailing Address
First Line : 13011 E ASPEN BLUFF LN
Second Line :
City : SPOKANE
State : WA
Zip : 99217-9809
Country : US
Telephone Number : 509-892-9399
Fax Number :
Provider Business Practice Location Address
First Line : 620 SHADOW LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-4119
Country : US
Telephone Number : 702-671-8525
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2006
Last Update Date : 03/21/2012

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