Individual
LYNETTE WILDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4200 STATE RD, ASHTABULA, OH 44004-6017
(440) 576-9023
Mailing address
4200 STATE RD, ASHTABULA, OH 44004-6017
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
07172
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07172
LICENSE NUMBER
OH
Enumeration date
02/07/2014
Last updated
02/07/2014
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