MEDICARE: PAULA F WILDER FNP

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	163WG0000X	General Practice Registered Nurse	73605	TN
2	363LF0000X	Family Nurse Practitioner	0000006154	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902810906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA F WILDER FNP

Provider Business Mailing Address
First Line	:	5547 GLENWILD AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-6011
Country	:	US
Telephone Number	:	901-857-8925
Fax Number	:

Provider Business Practice Location Address
First Line	:	5547 GLENWILD AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-6011
Country	:	US
Telephone Number	:	901-857-8925
Fax Number	:

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	04/09/2009

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