Healthcare Provider Details

I. General information

NPI: 1508062241
Provider Name (Legal Business Name): KATIA WILDER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OROVILLE HOSPITAL ED 2767 OLIVE HWY
OROVILLE CA
95966
US

IV. Provider business mailing address

PO BOX 7362
CHICO CA
95927-7362
US

V. Phone/Fax

Practice location:
  • Phone: 530-533-8500
  • Fax:
Mailing address:
  • Phone: 530-534-9625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12559
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: