Basic Information
| Provider Information | |||||||||
| NPI: | 1508447848 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILDER | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5775 JULIAN AIRPORT RD | ||||||||
| Address2: | |||||||||
| City: | LIBERTY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272988036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362537463 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2706 N CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274053657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362729990 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2021 | ||||||||
| LastUpdateDate: | 04/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 376K00000X | 376682 | NC | Y | Nursing Service Related Providers | Nurse's Aide |
No ID Information.