Individual
MS. MIKISA WILDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NCMA
Contact information
Practice address
5502 CEDAR AVE APT 1A, PHILADELPHIA, PA 19143-1930
(267) 973-2312
Mailing address
5502 CEDAR AVE APT 1A, PHILADELPHIA, PA 19143-1930
(267) 973-2312
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
503146
PA
Other
Enumeration date
01/15/2018
Last updated
01/15/2018
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