Individual ProviderMary WildemanNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address926 Main St, Nashville, TN 37206-3614(615) 436-9060(812) 306-4757PECOS EnrollmentBased on the most recent information from CMS, provider Mary Wildeman is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 6 days ago.Profile DetailsProvider ID1790379618Provider TypeIndividualFull NameWildeman, MaryGenderFemaleSole ProprietorNoEnumeration Date2/22/2021Last Updated1/7/2025Contact InformationPractice LocationPractice Address926 Main St, Nashville, TN 37206-3614Phone(615) 436-9060Fax(615) 235-9725Mailing LocationMailing Address10400 Far View Dr, Evansville, IN 47712-8946Phone(812) 306-4757FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense28203347AIndiana