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1861769648
MARIA THERESA LICERALDE WYSON
ELK GROVE, CA
NPI
1861769648
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Former Name
MARIA THERESA SIDECO LICERALDE
Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: CA 21360)
Enumeration Date
2011-11-22
Last Update Date
2023-03-07
Business Address
MARIA THERESA LICERALDE WYSON MSN, FNP-C
7811 LAGUNA BLVD STE 161
ELK GROVE, CA 95758-7949
Phone number: 916-877-7778
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Mailing Address
MARIA THERESA LICERALDE WYSON MSN, FNP-C
11592 LINDAY WAY
GOLD RIVER, CA 95670-6233
Phone number: 916-213-2570
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