Healthcare Provider Details

I. General information

NPI: 1336862754
Provider Name (Legal Business Name): SARAH WYLDS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10541 HARRISON AVE
HARRISON OH
45030-1943
US

IV. Provider business mailing address

858 BEECHWOOD CIR
LAWRENCEBURG IN
47025-9349
US

V. Phone/Fax

Practice location:
  • Phone: 513-202-0134
  • Fax:
Mailing address:
  • Phone: 513-923-0252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0032056
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: