| Doctor Name: | MRS. JENNIFER WILDE |
| NPI Number: | 1033190574 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | F.N.P. |
| License Number: | 098006694NP |
| Business Practice Address: | 1810 E 19th St Suite 209 The Dalles, OR - 970583388 |
| Business Phone Number: | 5412965657 |
| Business Fax Number: | |
| Mailing Address: | Po Box 1520, THE DALLES |
| State: | OR |
| Postal Code: | 970588003 |
| Phone Number: | 5412965657 |
| Fax Number: | |
| NPI Enumeration Date: | 11/10/2005 |
| NPI Last Update Date: | 12/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 098006694NP |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |