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Individual
PAMELA ROSE WILDER
Active
Individual
PAMELA ROSE WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
62370
NE
363L00000X
Nurse Practitioner
Primary
1-157417
AL
Other
Enumeration date
08/16/2016
Last updated
09/23/2016
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