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NPI Code Detail

MEDICARE: MS. BRITTANI LOUISE WILDE CNM

MEDICARE: MS. BRITTANI LOUISE WILDE CNM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367A00000XAdvanced Practice MidwifeTX

General Provider Information

NPI Number : 1285411751
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. BRITTANI LOUISE WILDE CNM
Provider Business Mailing Address
First Line : 2807 STANLEY AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-2934
Country : US
Telephone Number : 254-231-2651
Fax Number :
Provider Business Practice Location Address
First Line : 622 HEMPHILL ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-3179
Country : US
Telephone Number : 817-878-2737
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2023
Last Update Date : 09/11/2023

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