Basic Information
| Provider Information | |||||||||
| NPI: | 1215202130 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILDER | ||||||||
| FirstName: | EVELYN | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3012 NOTRE DAME DR | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958263512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168371662 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5821 JAMESON CT | ||||||||
| Address2: | |||||||||
| City: | CARMICHAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956080890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164860411 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2012 | ||||||||
| LastUpdateDate: | 03/09/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | 698623 | CA | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 363LF0000X | NP 20906 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.