MEDICARE: FELICIA WILDER

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
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1629622667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELICIA WILDER

Provider Business Mailing Address
First Line	:	6939 GEORGIA AVE NW APT 205
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20012-2439
Country	:	US
Telephone Number	:	202-415-7635
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 7TH ST NW APT 511
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20001-3132
Country	:	US
Telephone Number	:	202-588-7525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2019
Last Update Date	:	07/29/2019

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Directions to “ FELICIA WILDER ” Practice Location

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