Provider Demographics
NPI:1235660929
Name:WILDES, MEGAN GRACE (ARNP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:GRACE
Last Name:WILDES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:DR
Other - First Name:MEG
Other - Middle Name:
Other - Last Name:WILDES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP
Mailing Address - Street 1:5006 CENTER ST STE U
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-2314
Mailing Address - Country:US
Mailing Address - Phone:253-284-4488
Mailing Address - Fax:253-272-4771
Practice Address - Street 1:5006 CENTER ST STE U
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-2314
Practice Address - Country:US
Practice Address - Phone:253-284-4488
Practice Address - Fax:253-272-4771
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60733408363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner