Provider Information for 1538674957
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ELIZABETH M WILDE
Sex: Female
NPI: 1538674957
Last Updated: 2017-12-07
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1538674957 | ||||||||
| Enumeration Date | 2017-12-07 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 511 PERRY ST DEFIANCE, OH 43512-2123 United States Phone: 419-782-9920 | Fax:419-784-2523 | ||||||||
| Primary Practice Address | 511 PERRY ST DEFIANCE, OH 43512-2123 United States Phone: 419-782-9920 | Fax:419-784-2523 | ||||||||
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