Individual
AMANDA MARIE WILDERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1100 W DIANN LN, CARBONDALE, IL 62901-5339
(618) 549-8006
(618) 549-8434
Mailing address
1268 COLE PLACE RD, CHESTER, IL 62233-2054
(618) 210-7478
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
209.020318
IL
Other
Enumeration date
10/29/2019
Last updated
03/24/2023
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