Provider Demographics
NPI:1386452092
Name:WILDASIN, HAILEY LIN
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:LIN
Last Name:WILDASIN
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 1:5765 CENTRE AVE APT 213
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-5702
Mailing Address - Country:US
Mailing Address - Phone:717-479-6712
Mailing Address - Fax:
Practice Address - Street 1:VB 360A 3500 VICTORIA STREET
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15261-0001
Practice Address - Country:US
Practice Address - Phone:412-624-4586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-27
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN772063163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse