Individual
MRS. JACKI L WILDEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
4007 GATEWAY BLVD # 100, NEWBURGH, IN 47630-8947
(812) 842-0907
(812) 490-7054
Mailing address
4015 GATEWAY BLVD STE 2120, NEWBURGH, IN 47630-9460
(812) 842-0907
(812) 464-4485
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71001467A
IN
363LA2100X
Acute Care Nurse Practitioner
28079891A
IN
363LA2100X
Acute Care Nurse Practitioner
309002150
IL
363LA2100X
Acute Care Nurse Practitioner
3899P
KY
363LA2100X
Acute Care Nurse Practitioner
71001467A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000270530
ANTHEM
—
05
—
200427140
—
IN
05
—
78009586
—
KY
Enumeration date
05/05/2006
Last updated
12/06/2019
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