Individual
MS. PAMELA LYNNE WILDERMUTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4227 SESTOS DR, COLUMBUS, OH 43207-8423
(614) 497-8149
Mailing address
4227 SESTOS DR, COLUMBUS, OH 43207-8423
(614) 497-8149
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
PN110992
OH
Other
Enumeration date
08/02/2006
Last updated
07/08/2007
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