Individual
DR. LISA ANNE WILDMO
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
AU.D.
Contact information
Practice address
1318 MEMORIAL DR, STE 201, BRYAN, TX 77802-5215
(979) 776-2088
Mailing address
1318 MEMORIAL DR, STE 201, BRYAN, TX 77802-5215
(979) 776-2088
Taxonomy
Speciality
Code
Description
License number
State
237600000X
Audiologist-Hearing Aid Fitter
Primary
51242
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
528479
BCBS
TX
01
—
7040537
AETNA
TX
Enumeration date
06/15/2005
Last updated
07/08/2007
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