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General NPI Number Information
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NPI Number | 1770577322
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Entity Type | Individual
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Provider Name | BERNICE JOANN WILDER DNP, ARNP, BC
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Gender | Female
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 05/03/2019
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Provider Practice Location Address
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Address Line | MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
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City | TACOMA
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State | WA
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Zip | 98438-1336
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Country | US
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Telephone | 253-982-3685
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Fax | 253-982-9037
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Provider Business Mailing Address
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Address Line | 101 BODIN CIRCLE DAVID GRANT MEDICAL CENTER
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City | TRAVIS AFB
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State | CA
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Zip | 94535
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Country | US
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Telephone | 707-423-5174
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Fax | 707-423-5144
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | RN00096394
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP0003838
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License Number State | WA
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