Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Amanda Marie Wilderman

Individual provider Adult Medicine Physician · NPI 1659915171

Amanda Marie Wilderman is a Nurse Practitioner in Carbondale, Illinois. Qualified in 2019, 7 years ago. Practices as a sole proprietor and works from 2 locations. Licensed in Illinois.

Years since qualifying
7
Licensed in
IL
In the registry since
2019

Practice location Address checks out

1100 W Diann Ln
Carbondale, IL 62901-5339
Phone: (618) 549-8006
Fax: (618) 549-8434
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1309 Allendale Blvd, Chester, IL 62233-1319 — (618) 497-4264

Specialties & licences

Adult Medicine Physician (primary) Taxonomy 207QA0505X · Licence 209.020318 (IL)

Record details

NPI number1659915171
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedOctober 29, 2019
Last updated in NPPESMarch 24, 2023
Certification dateMarch 24, 2023
Mailing address1268 Cole Place Rd, Chester, IL 62233-2054

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

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