Individual
NAOMI NICOLE WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1205 TROY SCHENECTADY RD STE 101, LATHAM, NY 12110-1074
(518) 348-3176
Mailing address
1101 NOTT ST, SCHENECTADY, NY 12308-2425
(518) 243-4000
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
012007
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01529253
—
NY
Enumeration date
09/12/2007
Last updated
10/24/2019
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