Robert Earl Wildwood, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

822435 Issued in MN

Practice address

935 Kenwood Ave
Duluth, MN 55811-4951

Phone

(218) 396-3787

NPI assigned

Aug 19, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1629331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1639845795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1225 E 11TH ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051559",
            "telephone_number": "612-558-7273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "935 KENWOOD AVE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558114951",
            "telephone_number": "218-396-3787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDWOOD",
        "first_name": "ROBERT",
        "middle_name": "EARL",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-19",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "MN",
            "license": "822435",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aaron Joseph Wilcox, PT
• Jacob Avery Wilcox, MD
• Rachel Marie Wilcox, MD
• Kim L Wilde, MD
• Wilderness Wellness Chiropractic LLC
• Sonja Wildwood, LPCC
• Elizabeth Jean Wilhelmson, P.T.
• Krista Wilhelmson, MD
• Kristine Marie Wilke, A.T.C-L
• Nicole Marie Wilke, FNP-BC, APNP

• Licensed Practical Nurse in Duluth, MN
• Providers in Duluth, MN by specialty
• Licensed Practical Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; 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.