Individual
TERRA WILDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DNP
Contact information
Practice address
1814 105TH ST SE, EVERETT, WA 98208-4816
(425) 225-3425
Mailing address
PO BOX 5127, EVERETT, WA 98206-5127
(425) 339-5453
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP60765620
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2081564
—
WA
Enumeration date
06/20/2017
Last updated
09/02/2022
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