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NPI Code Detail

MEDICARE: DR. VIRGINIA DAGGETT WILDER PHD, MSN, RN

MEDICARE: DR. VIRGINIA DAGGETT WILDER PHD, MSN, RN
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
1163W00000XRegistered Nurse041.304192IL
2163W00000XRegistered Nurse28191988AIN

General Provider Information

NPI Number : 1619177557
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. VIRGINIA DAGGETT WILDER PHD, MSN, RN
Provider Business Mailing Address
First Line : 499 HERITAGE DR
Second Line :
City : MACKINAW
State : IL
Zip : 61755-8999
Country : US
Telephone Number : 309-256-3570
Fax Number :
Provider Business Practice Location Address
First Line : 1481 W 10TH ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-2803
Country : US
Telephone Number : 317-988-3155
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2007
Last Update Date : 01/23/2017

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