Mary Deloris Wilder, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

90455-030 Issued in WI

Practice address

9851 W. Dean Rd
Milwaukee, WI 53224

Phone

(414) 365-6463

Fax

(414) 365-6463

NPI assigned

Sep 5, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Ms. Mary Deloris Sloan Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1220572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1220572800000",
    "number": "1124276977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9851 W. DEAN RD",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53224",
            "telephone_number": "414-365-6463",
            "fax_number": "414-365-6463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9851 W. DEAN RD",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "53224",
            "telephone_number": "414-365-6463",
            "fax_number": "414-365-6463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDER",
        "first_name": "MARY",
        "middle_name": "DELORIS",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-09-05",
        "last_updated": "2008-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "90455-030",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "35064200",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENT NURSE RN",
            "identifier": "33/075",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "SLOAN",
            "middle_name": "DELORIS",
            "prefix": "MS.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kristen Wilde, MD
• Ana Elizabeth Wilden
• Bridgett Lynn Wilder
• Danyale Lenora Wilder, LPN
• Ellicia Wilder, LPC-IT, SAC-IT
• Shanika J Wilder
• Tamiko Wilder
• Micah Wildes, MD
• Sharon Wildes, R.D.H.
• Noah Allen Wiles

• Registered Nurse in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Registered Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.