Individual
BRETT ALAN WILDRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1500 NE IRVING ST, SUITE 250, PORTLAND, OR 97232-2243
(503) 258-4200
Mailing address
5776 KALMIA LN, SPRINGFIELD, OR 97478-5453
(541) 337-2848
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
11/07/2010
Last updated
11/07/2010
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