Provider Demographics
NPI:1427387745
Name:WILBER, BRADLEY S (RN, BSN, CRNA)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:S
Last Name:WILBER
Suffix:
Gender:M
Credentials:RN, BSN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10301 HICKMAN MILLS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64137-1674
Mailing Address - Country:US
Mailing Address - Phone:816-767-3210
Mailing Address - Fax:
Practice Address - Street 1:5721 W 119TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3722
Practice Address - Country:US
Practice Address - Phone:913-498-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE63533163W00000X
KS14-594413-051163W00000X
KS43-556966-051367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse