Basic Information
| Provider Information | |||||||||
| NPI: | 1427387745 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILBER | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RN, BSN, CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10301 HICKMAN MILLS DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641371674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8167673210 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5721 W 119TH ST | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662093722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134986000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2009 | ||||||||
| LastUpdateDate: | 07/09/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 63533 | NE | N | Nursing Service Providers | Registered Nurse | 163W00000X | 14-594413-051 | KS | N | Nursing Service Providers | Registered Nurse | 367500000X | 43-556966-051 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.