Provider Demographics
NPI:1932993268
Name:POMA, WILDER RUBEN
Entity type:Individual
Prefix:
First Name:WILDER
Middle Name:RUBEN
Last Name:POMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 ROLLSTONE ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-4299
Mailing Address - Country:US
Mailing Address - Phone:978-516-8555
Mailing Address - Fax:
Practice Address - Street 1:147 ROLLSTONE ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-4299
Practice Address - Country:US
Practice Address - Phone:978-516-8555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN1003479164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty