Individual
MR. DALE WILDER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1518 MULBERRY AVE, MUSCATINE, IA 52761-3433
(563) 264-9100
Mailing address
1518 MULBERRY AVE, MUSCATINE, IA 52761-3433
(563) 264-9100
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
068515
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2055111
—
IA
Enumeration date
01/16/2006
Last updated
07/08/2007
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