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General NPI Number Information
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NPI Number | 1598572919
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Entity Type | Individual
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Provider Name | WYATT POWER RN
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Gender | Male
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Dates
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Enumeration Date | 12/18/2024
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 28062 BAXTER RD
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City | MURRIETA
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State | CA
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Zip | 92563-1401
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Country | US
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Telephone | 951-290-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 24270 LUNA BRILLA LN
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City | MURRIETA
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State | CA
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Zip | 92562-7701
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Country | US
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Telephone | 951-973-9375
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95034043
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 95240447
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License Number State | CA
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