Healthcare Provider Details

I. General information

NPI: 1184375834
Provider Name (Legal Business Name): AMY WILDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S 5TH ST
READING PA
19602-1662
US

IV. Provider business mailing address

200 N 7TH ST
LEBANON PA
17046-5040
US

V. Phone/Fax

Practice location:
  • Phone: 610-685-2188
  • Fax:
Mailing address:
  • Phone: 717-272-5464
  • Fax: 717-376-1712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: