Provider Demographics
NPI:1538157276
Name:WILDERMUTH, DEE A (ARNP)
Entity type:Individual
Prefix:
First Name:DEE
Middle Name:A
Last Name:WILDERMUTH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9674 SAMISH ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:WA
Mailing Address - Zip Code:98232-9349
Mailing Address - Country:US
Mailing Address - Phone:360-766-4183
Mailing Address - Fax:360-715-8416
Practice Address - Street 1:1903 D ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-3203
Practice Address - Country:US
Practice Address - Phone:360-941-0634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006114363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner