Healthcare Provider Details

I. General information

NPI: 1215727102
Provider Name (Legal Business Name): BRITTANY WYLD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY SPENCER

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 ELISHA AVE
ZION IL
60099-2676
US

IV. Provider business mailing address

1908 76TH ST
KENOSHA WI
53143-5853
US

V. Phone/Fax

Practice location:
  • Phone: 520-405-3296
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number247523
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: