NPI | 1891417283 |
---|---|
Former Name | ALYSSA WICHMANN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: IL 209.025451) |
Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics (Licence: MO 2022034477) |
Enumeration Date | 2022-09-13 |
Last Update Date | 2024-04-26 |