NPI | 1114225174 |
---|---|
Former Name | SARAH LYNN WYSOSKI |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 2768) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 13640) |
Enumeration Date | 2011-03-01 |
Last Update Date | 2021-06-10 |