Provider Demographics
NPI:1679910988
Name:WILDER, BRIDGET ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ANNE
Last Name:WILDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3103
Mailing Address - Country:US
Mailing Address - Phone:401-789-1422
Mailing Address - Fax:
Practice Address - Street 1:1 HIGH ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3103
Practice Address - Country:US
Practice Address - Phone:401-789-1422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4703363A00000X
CT2908363A00000X
RIPA00732363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant