Individual
MRS. OLIVIA JO WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
7000 N MO PAC EXPY STE 420, AUSTIN, TX 78731-3055
(512) 482-0045
(512) 476-9892
Mailing address
7000 N MO PAC EXPY STE 420, AUSTIN, TX 78731-3055
(512) 482-0045
(512) 476-9892
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
759769
TX
363LF0000X
Family Nurse Practitioner
759769
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
354595603
—
TX
Enumeration date
04/02/2013
Last updated
10/09/2020
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