Wilder, Lisa

Wilder, Lisa is an individual health care provider with primary practice located at 2601 Ferry St , Lafayette IN 47904-3061. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer, which is considered as her primary health care specialty. Wilder, Lisa can be contacted via phone (765) 448-8000.

Contact Information

Primary practice address
2601 Ferry St Lafayette IN 47904-3061
Phone: (765) 448-8000
Fax: (765) 448-8335
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer 2255A2300X 36000397A Indiana

Profile Details

NPI number 1902866502
LBN Legal business name Wilder, Lisa
Credentials Athletic Trainer, Certified (ATC)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 27th, 2006
Last updated Jul 9th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902866502 NPPES
Indiana MEDICAID NE18586065
Indiana Other 000000188968

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