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NPI Code Detail

MEDICARE: MRS. REGINA ANN WILDE NURSE PRACTITIONER

MEDICARE: MRS. REGINA ANN WILDE NURSE PRACTITIONER
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
1363L00000XNurse PractitionerNP-08305OH
2363LP0808XPsychiatric/Mental Health Nurse PractitionerNP 08305OH

General Provider Information

NPI Number : 1689670168
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. REGINA ANN WILDE NURSE PRACTITIONER
Provider Business Mailing Address
First Line : 1490 UNIVERSITY BLVD
Second Line :
City : HAMILTON
State : OH
Zip : 45011-3305
Country : US
Telephone Number : 513-881-7189
Fax Number : 513-881-7188
Provider Business Practice Location Address
First Line : 1490 UNIVERSITY BLVD
Second Line :
City : HAMILTON
State : OH
Zip : 45011-3305
Country : US
Telephone Number : 513-881-7189
Fax Number : 513-881-7188
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2005
Last Update Date : 11/15/2016

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Directions to “ MRS. REGINA ANN WILDE NURSE PRACTITIONER” Practice Location

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