Individual
LYNETTE WILDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
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
Update your record
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