Individual
MR. JUSTIN WILDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
201 LAVACA ST, AUSTIN, TX 78701-3960
(754) 234-0938
Mailing address
201 LAVACA ST, AUSTIN, TX 78701-3960
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
930303
TX
Other
Enumeration date
10/14/2017
Last updated
10/14/2017
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