PETER NELSON WILDEBOER DO
NPI 1912693193
Student in an Organized Health Care Education/Training Program in Fayetteville, NC

Q: What is Peter Wildeboer's NPI number?

The NPI number for Peter Wildeboer is 1912693193. It was assigned to this individual provider in the NPPES registry on April 12, 2023.

Q: What is Peter Wildeboer's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Peter Wildeboer was last updated on April 12, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since April 12, 2023PECOS Enrolled

1638 OWEN DR, FAYETTEVILLE, NC 28304(910) 615-4000 Get Directions Write a Review

NPPES record last updated: April 12, 2023. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Peter Nelson Wildeboer Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PETER NELSON WILDEBOER DO (NPI 1912693193) is an individual student in an organized health care education/training program in Fayetteville, North Carolina and active in the NPI registry since April 2023. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1912693193

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NamePETER NELSON WILDEBOERCredential: DO

Location Address1638 OWEN DRFayetteville, NC 28304-3424

Mailing Address1638 Owen DrFayetteville, NC 28304-3424 · (910) 615-4000

Phone(910) 615-4000

Sole ProprietorNo

Enumeration DateApril 12, 2023

NPPES CertifiedApril 12, 2023

✔ NPI 1912693193 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

1638 OWEN DR, Fayetteville, NC 28304

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Peter Nelson Wildeboer Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.