Provider Demographics
NPI:1558508143
Name:WILDER, ALLISON M (RN)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:M
Last Name:WILDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 INVERNESS DR W
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4200 W CONEJOS PL
Practice Address - Street 2:#516
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-1333
Practice Address - Country:US
Practice Address - Phone:303-629-3717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO184858163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse