Healthcare Provider Details

I. General information

NPI: 1568866960
Provider Name (Legal Business Name): MR. RYAN JAMES WILSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5513 ODANA RD
MADISON WI
53719-1205
US

IV. Provider business mailing address

5513 ODANA RD
MADISON WI
53719-1205
US

V. Phone/Fax

Practice location:
  • Phone: 608-206-2595
  • Fax:
Mailing address:
  • Phone: 608-206-2595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1374-60
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: