Healthcare Provider Details

I. General information

NPI: 1144986878
Provider Name (Legal Business Name): WENDI MICHELLE WILDER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 08/06/2025
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2946 E BANNER GATEWAY DR
GILBERT AZ
85234-2165
US

IV. Provider business mailing address

2946 E BANNER GATEWAY DR
GILBERT AZ
85234-2165
US

V. Phone/Fax

Practice location:
  • Phone: 480-256-6444
  • Fax: 480-256-3359
Mailing address:
  • Phone: 480-256-6444
  • Fax: 480-256-3359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number266803
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: