NPI 1811043862

Bryce David Wylie, PAC

Practitioner Physician Assistant Saint Anthony, ID

Practice location

Address: 335 E Main St STE 1, Saint Anthony, ID 83445-1546
Phone: (208) 356-4900
Fax: (208) 624-4116
Mailing address: PO Box 18, Saint Anthony, ID 83445-0018

Registered specialties

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence PA-1013 (ID)

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Registry record

NPI: 1811043862
Entity type: Individual
Sex (as registered): Male
NPI issued: 25 Jan 2007
Record last updated: 11 Mar 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.