Individual
AUDREY ANNE WILDEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3021 REIDVILLE RD, SPARTANBURG, SC 29301-5643
(864) 576-9201
(864) 576-6584
Mailing address
3021 REIDVILLE RD, SPARTANBURG, SC 29301-5643
(864) 576-9201
(864) 576-6584
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2742
SC
Other
Enumeration date
08/22/2017
Last updated
08/22/2017
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