| NPI | 1346416096 |
|---|---|
| Former Name | ANGELA VANESSA WILDER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 2176) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: LA 2176) |
| Enumeration Date | 2008-05-02 |
| Last Update Date | 2008-05-02 |