Provider Demographics
NPI:1699196709
Name:WAYLAND, BRIAN KEITH (RN)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:KEITH
Last Name:WAYLAND
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WENARK DR APT 7
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-1406
Mailing Address - Country:US
Mailing Address - Phone:302-299-7350
Mailing Address - Fax:
Practice Address - Street 1:3 WENARK DR APT 7
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-1406
Practice Address - Country:US
Practice Address - Phone:302-299-7350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0037014103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst