Individual
MRS. MARY DELORIS WILDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
9851 W. DEAN RD, MILWAUKEE, WI 53224
(414) 365-6463
(414) 365-6463
Mailing address
9851 W. DEAN RD, MILWAUKEE, WI 53224
(414) 365-6463
(414) 365-6463
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
90455-030
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33/075
INDEPENDENT NURSE RN
—
05
—
35064200
—
WI
Enumeration date
09/05/2008
Last updated
09/05/2008
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