Individual ProviderNijera Shanel WildmanStudent in an Organized Health Care Education/Training ProgramStudent, Health CarePractice Address17235 N 75th Ave Ste F100, Glendale, AZ 85308-0871(480) 641-1165PECOS EnrollmentBased on the most recent information from CMS, provider Nijera Shanel Wildman does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 8 days ago.Profile DetailsProvider ID1801480736Provider TypeIndividualFull NameWildman, Nijera ShanelGenderFemaleSole ProprietorNoEnumeration Date2/22/2021Last Updated2/22/2021Contact InformationPractice LocationPractice Address17235 N 75th Ave Ste F100, Glendale, AZ 85308-0871Phone(480) 641-1165FaxUnlisted FaxMailing LocationMailing Address17235 N 75th Ave, Glendale, AZ 85308-0831Phone(480) 641-1165FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode390200000XPrimaryDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted IssuerArizona