Provider Demographics
NPI:1285185231
Name:WILDEMAN, MARCELLA (DNP, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MARCELLA
Middle Name:
Last Name:WILDEMAN
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 JACKSON AVE # A
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2708
Mailing Address - Country:US
Mailing Address - Phone:307-675-5555
Mailing Address - Fax:
Practice Address - Street 1:916 JACKSON AVE # A
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2708
Practice Address - Country:US
Practice Address - Phone:130-767-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60701532363LF0000X
WY48029363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily