Provider Demographics
NPI:1386472108
Name:WILDER, JAMERE DENISE
Entity type:Individual
Prefix:
First Name:JAMERE
Middle Name:DENISE
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 1:4076 OKALONA RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2624
Mailing Address - Country:US
Mailing Address - Phone:216-937-5103
Mailing Address - Fax:
Practice Address - Street 1:4076 OKALONA RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-2624
Practice Address - Country:US
Practice Address - Phone:216-937-5103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)