Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | PA14526 | TX |
N | 213ES0000X | Sports Medicine | PA14526 | TX |
NPI | 1255915369 |
---|---|
Provider Name | Harley Danielle Wilde |
First Address | Mcallen, TX 78502-6139 |
Second Address | Edinburg, TX 78539-1422 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2021 |
Last Update Date | 05/02/2022 |