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General NPI Number Information
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NPI Number | 1932854908
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Entity Type | Organization
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Legal Business Name | THE DUFF WILDER GROUP, LLC
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Dates
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Enumeration Date | 02/17/2022
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Last Update Date | 03/18/2022
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Provider Practice Location Address
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Address Line | 208 10TH ST NE
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City | GORDO
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State | AL
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Zip | 35466-2754
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Country | US
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Telephone | 205-399-7795
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 804
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City | GORDO
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State | AL
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Zip | 35466-0804
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Country | US
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Telephone | 205-399-7795
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. SONDRA DUFF WILDER
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Credential | FNP-BC; PMHNP-BC
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Telephone | 205-399-7795
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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