Individual
DYLAN WADDILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
902 LAKEVIEW AVE, PUEBLO, CO 81004-3597
(719) 557-5855
(719) 557-5097
Mailing address
902 LAKEVIEW AVE, PUEBLO, CO 81004-3597
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/14/2025
Last updated
07/18/2025
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