Individual
MRS. JERRICA MARIE WILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15301 WARREN SHINGLE ROAD, BEALE AFB, CA 95903
(530) 634-4738
Mailing address
15301 WARREN SHINGLE RD, BEALE AFB, CA 95903-1907
(530) 634-4738
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
05/26/2011
Last updated
11/22/2011
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