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NPI Code Detail

MEDICARE: BRENT W WILDER

MEDICARE: BRENT W WILDER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1372600000XAdult Companion

General Provider Information

NPI Number : 1548147895
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENT W WILDER
Provider Business Mailing Address
First Line : 3841 N FREEWAY BLVD STE 245
Second Line :
City : SACRAMENTO
State : CA
Zip : 95834-1969
Country : US
Telephone Number : 916-441-0226
Fax Number :
Provider Business Practice Location Address
First Line : 3841 N FREEWAY BLVD STE 245
Second Line :
City : SACRAMENTO
State : CA
Zip : 95834-1969
Country : US
Telephone Number : 916-441-0226
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2025
Last Update Date : 08/19/2025

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Directions to “ BRENT W WILDER ” Practice Location

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