Individual
HEATHER WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
415 N JACKSON ST # 1348, AMERICUS, GA 31709-3015
(229) 815-5454
Mailing address
415 N JACKSON ST, AMERICUS, GA 31709-3015
(229) 815-5454
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN102679
GA
Other
Enumeration date
05/25/2023
Last updated
05/25/2023
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