Provider Demographics
NPI:1306514823
Name:WILDER, AZARHIA
Entity type:Individual
Prefix:
First Name:AZARHIA
Middle Name:
Last Name:WILDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 N MAYFAIR RD STE 230
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2263
Mailing Address - Country:US
Mailing Address - Phone:262-692-2117
Mailing Address - Fax:
Practice Address - Street 1:2222 N MAYFAIR RD STE 230
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2263
Practice Address - Country:US
Practice Address - Phone:262-692-2117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver