Individual
STEPHANIE ABIMBOLA OLAWAIYE WILDERNESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6621 FANNIN ST, HOUSTON, TX 77030-2399
(832) 826-1075
Mailing address
6621 FANNIN ST, HOUSTON, TX 77030-2399
(832) 826-1075
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA12712
TX
Other
Enumeration date
03/30/2019
Last updated
09/10/2022
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