Provider Demographics
NPI:1134174337
Name:WILDER, JANICE F (CNM)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:F
Last Name:WILDER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W 10TH AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6302
Mailing Address - Country:US
Mailing Address - Phone:509-586-5897
Mailing Address - Fax:509-586-5898
Practice Address - Street 1:320 W 10TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6302
Practice Address - Country:US
Practice Address - Phone:509-586-5860
Practice Address - Fax:509-586-5120
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003088367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9608506Medicaid
S69412Medicare UPIN
WA9608506Medicaid