Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
AMANDA MARIE WILDERMAN
Active Sole ProprietorAMANDA MARIE WILDERMAN is a Adolescent Medicine healthcare provider located in CARBONDALE, Illinois. NPI 1659915171 is currently active in the NPPES registry. Verify at CMS.
Adolescent Medicine · CARBONDALE, IL
Registration Details
- NPI Number
- 1659915171
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Oct 29, 2019 (6.8216553159929 yrs)
- Last Updated
- Mar 24, 2023
- License
-
209.020318 (IL)
- Sole Proprietor
- Yes
Practice Information
- Address
-
1100 W DIANN LNCARBONDALE, IL, 629015339Browse IL providers · Browse ZIP 62901
- Phone
- 6185498006
- Fax
- 6185498434
- Primary Specialty
-
Adolescent Medicine
207QA0505X
Other Adolescent Medicine Providers in CARBONDALE, IL
| Name | Credential | NPI |
|---|---|---|
| DR. ROLLIN MORRIS PERKINS III | MD | 1669553681 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.