Healthcare Provider Details

I. General information

NPI: 1245911494
Provider Name (Legal Business Name): CHELSEA SUZANNE WILDMAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 N BROADWAY
HERINGTON KS
67449-2402
US

IV. Provider business mailing address

6 N BROADWAY
HERINGTON KS
67449-2402
US

V. Phone/Fax

Practice location:
  • Phone: 785-258-6028
  • Fax:
Mailing address:
  • Phone: 785-258-6028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-85763-111
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number151788
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: