Provider Demographics
NPI:1316458128
Name:WILDE, AUDREY MARIE (RNC)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:MARIE
Last Name:WILDE
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15940 AVONDALE RD NE
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98077-9167
Mailing Address - Country:US
Mailing Address - Phone:425-408-4206
Mailing Address - Fax:425-408-4202
Practice Address - Street 1:15940 AVONDALE RD NE
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98077-9167
Practice Address - Country:US
Practice Address - Phone:425-408-4206
Practice Address - Fax:425-408-4202
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00085706163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool