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NPI Code Detail

MEDICARE: DR. ERIN NICOLE WILDERMUTH MD

MEDICARE: DR. ERIN NICOLE WILDERMUTH MD
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
1390200000XStudent in an Organized Health Care Education/Training ProgramNC

General Provider Information

NPI Number : 1740111590
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ERIN NICOLE WILDERMUTH MD
Provider Business Mailing Address
First Line : 101 MANNING DR # 7160
Second Line :
City : CHAPEL HILL
State : NC
Zip : 27514-4226
Country : US
Telephone Number : 984-974-5217
Fax Number :
Provider Business Practice Location Address
First Line : 101 MANNING DR # 7160
Second Line :
City : CHAPEL HILL
State : NC
Zip : 27514-4226
Country : US
Telephone Number : 984-974-5217
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2026
Last Update Date : 05/28/2026

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