Healthcare Provider Details

I. General information

NPI: 1558508143
Provider Name (Legal Business Name): ALLISON M WILDER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2009
Last Update Date: 01/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 W CONEJOS PL #516
DENVER CO
80204-1333
US

IV. Provider business mailing address

188 INVERNESS DR W SUITE 500
ENGLEWOOD CO
80112-5205
US

V. Phone/Fax

Practice location:
  • Phone: 303-629-3717
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number184858
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: