Healthcare Provider Details

I. General information

NPI: 1750299319
Provider Name (Legal Business Name): NICOLE F WILDMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 COBB ST
CADILLAC MI
49601-2588
US

IV. Provider business mailing address

770 FITZHUGH DR APT 8
TRAVERSE CITY MI
49684-5603
US

V. Phone/Fax

Practice location:
  • Phone: 231-995-0411
  • Fax:
Mailing address:
  • Phone: 231-995-0411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: