Individual
TARYN WILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
790 RIDGE RD, LACKAWANNA, NY 14218-1629
(716) 828-9699
Mailing address
790 RIDGE RD, LACKAWANNA, NY 14218-1629
(716) 828-9699
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
09/17/2018
Last updated
09/17/2018
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