Healthcare Provider Details

I. General information

NPI: 1447186226
Provider Name (Legal Business Name): STEPHANIE NICOLE WILDMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E DONNA DR
MERCED CA
95340-0684
US

IV. Provider business mailing address

1200 E DONNA DR
MERCED CA
95340-0684
US

V. Phone/Fax

Practice location:
  • Phone: 209-793-0113
  • Fax:
Mailing address:
  • Phone: 209-793-0113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License NumberF4497674
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: