DR. JUSTIN RICHARD WILD (NPI# 1043500648) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043500648 |
| Entity Type | Individual |
| Full Name | DR. JUSTIN RICHARD WILD |
| Credential | D.D.S. |
| Practice Address |
9651 Wyoming Ter S Bloomington MN 55438-1606 |
| Practice Telephone | 9522378619 |
| Mailing Telephone | 9522378619 |
| Enumeration Date | 2011-04-15 |
| Last Update Date | 2011-04-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
9651 WYOMING TER S |
| City | BLOOMINGTON |
| State | MN |
| Zip Code | 55438-1606 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215283049 | Jordon Wild | Pharmacist | 9651 Wyoming Ter S, Bloomington, MN 55438-1606 | 2012-07-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912425570 | Angela Marie Gilbert | Registered Nurse | 10700 Brunswick Rd Unit 316, Bloomington, MN 55438 | 2017-09-05 |
| 1609905686 | Marypat Habermas | Pharmacist | 7349 Bush Lake Dr, Bloomington, MN 55438 | 2007-03-05 |
| 1629564620 | Andrea Jean Hegland | Pharmacist | One Veterans Drive, Pharmacy Service (119), Minneapolis, MN 55438 | 2018-07-03 |
| 1861050197 | Dustin James Javers | Physical Therapist | 8100 Highwood Dr, Bloomington, MN 55438-1006 | 2019-06-01 |
| 1285156240 | Dawn Marie Johnson | Occupational Therapy Assistant | 8100 Highwood Dr, Bloomington, MN 55438-1006 | 2017-07-12 |
| 1154777654 | Jennifer Bean | Occupational Therapy Assistant | 8100 Highwood Dr, Bloomington, MN 55438-1006 | 2016-05-13 |
| 1831588250 | Sia Bacas Langum | Occupational Therapist | 8100 Highwood Dr, Bloomington, MN 55438-1006 | 2015-01-22 |
| 1073948576 | Kathleen Ann Linnan Rudgers | Physical Therapy Assistant | 8100 Highwood Dr, Bloomington, MN 55438-1006 | 2013-09-04 |
| 1508201211 | Barbara Ann Spleiss | Occupational Therapy Assistant | 8100 Highwood Dr, Bloomington, MN 55438-1006 | 2013-05-08 |
| 1194160895 | Patty Norby | Physical Therapist | 8100 Highwood Dr, Bloomington, MN 55438-1006 | 2013-05-08 |
| Find all providers in zip 55438 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275132003 | Faizo A Hersi | Student in an Organized Health Care Education/Training Program | 9700 International Dr Suite 300, Bloomington, MN 55425 | 2020-10-22 |
| 1528689312 | Cody Schroeder | Student in an Organized Health Care Education/Training Program | 19 Norman Ridge Dr, Bloomington, MN 55437-1749 | 2020-05-03 |
| 1578117107 | Ingrid Alexis Lopez | Student in an Organized Health Care Education/Training Program | 9817 Vine St, Bloomington, CA 92316-2038 | 2019-07-31 |
| 1356907026 | Shannon G Freed | Student in an Organized Health Care Education/Training Program | 10660 Hampshire Ave S Apt 3102, Bloomington, MN 55438-2629 | 2019-05-17 |
| 1730649062 | Matthew Acton | Student in an Organized Health Care Education/Training Program | 2341 E Plateau Pl, Bloomington, IN 47401-9502 | 2019-03-22 |
| 1881158012 | Amber Caitlyn Bentley | Student in an Organized Health Care Education/Training Program | 701 N Walnut St Apt 211, Bloomington, IN 47404-4038 | 2019-01-22 |
| 1104337245 | Ashley Roy | Student in an Organized Health Care Education/Training Program | 1202 N Walnut St, Bloomington, IN 47404-3534 | 2017-10-16 |
| 1326584244 | Jonah Harrison Prickel | Student in an Organized Health Care Education/Training Program | 713 S Brighton Crst, Bloomington, IN 47401-8684 | 2017-01-17 |
| 1215327630 | Miranda Lofgren | Student in an Organized Health Care Education/Training Program | 2036 N Walnut St, Apt B17, Bloomington, IN 47404-2465 | 2015-01-24 |
| 1598154825 | Tyler Daniel Reems | Student in an Organized Health Care Education/Training Program | 935 S Copper Beech Way Apt E, Bloomington, IN 47403-5242 | 2015-01-09 |
| Find all providers in BLOOMINGTON | ||||
| City | BLOOMINGTON |
| Zip Code | 55438 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.