MEDICARE: DR. BERNICE JOANN WILDER DNP, ARNP, BC

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
1	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	RN00096394	WA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP0003838	WA

General Provider Information

NPI Number	:	1770577322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERNICE JOANN WILDER DNP, ARNP, BC

Provider Business Mailing Address
First Line	:	101 BODIN CIRCLE
Second Line	:	DAVID GRANT MEDICAL CENTER
City	:	TRAVIS AFB
State	:	CA
Zip	:	94535
Country	:	US
Telephone Number	:	707-423-5174
Fax Number	:	707-423-5144

Provider Business Practice Location Address
First Line	:	MADIGAN ARMY MEDICAL CENTER
Second Line	:	9040 JACKSON AVE
City	:	TACOMA
State	:	WA
Zip	:	98438-1336
Country	:	US
Telephone Number	:	253-982-3685
Fax Number	:	253-982-9037

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	05/03/2019

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