Jesse Ryan Wilder

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

2462373 Issued in MN

Practice address

16451 Snake TRL
Waseca, MN 56093-4310

Phone

(507) 380-1992

NPI assigned

Dec 12, 2021

Last updated

Dec 12, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1639267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639267200000",
    "number": "1417616913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16451 SNAKE TRL",
            "city": "WASECA",
            "state": "MN",
            "postal_code": "560934310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16451 SNAKE TRL",
            "city": "WASECA",
            "state": "MN",
            "postal_code": "560934310",
            "telephone_number": "507-380-1992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDER",
        "first_name": "JESSE",
        "middle_name": "RYAN",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-12-12",
        "last_updated": "2021-12-12",
        "certification_date": "2021-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "2462373",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Registered Nurse in Waseca, MN
• Providers in Waseca, MN by specialty
• Registered Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.