Individual
MR. BRYAN D WILDMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
1755 SULLIVAN LN, SPARKS, NV 89431-2815
(775) 499-5534
(775) 544-4259
Mailing address
1755 SULLIVAN LN, SPARKS, NV 89431-2815
(775) 499-5534
(775) 544-4259
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205389129
—
NV
Enumeration date
11/22/2019
Last updated
11/22/2019
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