Provider Demographics
NPI:1316748825
Name:WILDER, DENISE
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:WILDER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7238 ABERFELDY WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95842-1631
Mailing Address - Country:US
Mailing Address - Phone:707-342-0420
Mailing Address - Fax:
Practice Address - Street 1:425 VIRGINIA ST STE B
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-6017
Practice Address - Country:US
Practice Address - Phone:707-332-7825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator