Individual
MRS. TAMMY ANN WILDESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1952 NEW CREEK HWY, KEYSER, WV 26726-7494
(304) 597-3522
Mailing address
1952 NEW CREEK HWY, KEYSER, WV 26726-7494
(304) 597-3522
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP29110
MD
Other
Enumeration date
11/28/2022
Last updated
11/28/2022
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