Individual
JONATHAN MICHAEL WILDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
5101 W 73RD ST, PRAIRIE VILLAGE, KS 66208-2434
(619) 600-1023
Mailing address
5101 W 73RD ST, PRAIRIE VILLAGE, KS 66208-2434
(619) 600-1023
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1390081012
KS
367500000X
Certified Registered Nurse Anesthetist
0024168911
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
3906
CA
367500000X
Certified Registered Nurse Anesthetist
556930
KS
390200000X
Student in an Organized Health Care Education/Training Program
—
CA
Other
Enumeration date
06/16/2008
Last updated
10/18/2011
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