Individual
MISS THERESA EILEEN WILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
440 N MAIN ST # C, BRISTOL, CT 06010-4990
(860) 583-5858
(860) 584-9962
Mailing address
PO BOX 1280, BRISTOL, CT 06011-1280
(860) 583-5858
(860) 584-9962
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
E57029
CT
Other
Enumeration date
04/25/2007
Last updated
07/08/2007
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