Individual
CASEY WILDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
516 E NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1000
Mailing address
507 FARLEY ST, WAXAHACHIE, TX 75165-2752
(214) 632-4061
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
930837
TX
Other
Enumeration date
04/28/2020
Last updated
04/28/2020
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