MEDICARE: DANIELLE WILDERMAN CRNA, FNP-C

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	367500000X	Certified Registered Nurse Anesthetist	862955	TX

General Provider Information

NPI Number	:	1699178129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE WILDERMAN CRNA, FNP-C

Provider Business Mailing Address
First Line	:	245 MCKINLEY CIR
Second Line	:
City	:	WAXAHACHIE
State	:	TX
Zip	:	75167-0125
Country	:	US
Telephone Number	:	602-481-3316
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 LEGACY RANCH RD STE 102
Second Line	:
City	:	WAXAHACHIE
State	:	TX
Zip	:	75165-1293
Country	:	US
Telephone Number	:	254-724-2111
Fax Number	:

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

Provider Enumeration Date	:	09/29/2014
Last Update Date	:	03/10/2025

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