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Individual
MATTHEW JAMES WILD
Active
Individual
MATTHEW JAMES WILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
794010
NY
163W00000X
Registered Nurse
95325357
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
404299
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95024881
CA
Other
Enumeration date
06/22/2020
Last updated
08/30/2023
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