Active NPI
Margaret Ann Wilder, LMP
- Community Health Worker
- Bainbridge Island, WA
National Provider Identifier
1356683064
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- License
- MA00004399
- Practice address
- 390 Ericksen Ave NE
Bainbridge Island, WA 98110-1854 - Phone
- (206) 883-7422
- NPI assigned
- Mar 20, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | MA00004399 | WA | Primary |
Addresses
Primary practice location
390 Ericksen Ave NE
Bainbridge Island, WA 98110-1854
Mailing address
390 Ericksen Ave NE
Bainbridge Island, WA 98110-1854
Phone (206) 883-7422
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0152509 | Other | WA | LABOR AND INDUSTRIES |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA00004399 | WA | MD | Community Health Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1363737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363737600000",
"number": "1356683064",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "390 ERICKSEN AVE NE",
"city": "BAINBRIDGE ISLAND",
"state": "WA",
"postal_code": "981101854",
"telephone_number": "206-883-7422"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "390 ERICKSEN AVE NE",
"city": "BAINBRIDGE ISLAND",
"state": "WA",
"postal_code": "981101854",
"telephone_number": "206-883-7422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILDER",
"first_name": "MARGARET",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "LMP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-03-20",
"last_updated": "2013-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": "WA",
"license": "MA00004399",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR AND INDUSTRIES",
"identifier": "0152509",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bainbridge Island, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.