Individual
MRS. LEAH WISER
Active
Individual
MRS. LEAH WISER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601002257
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0853911050
BLUE CROSS BLUE SHIELD
—
01
—
0C94735
BCBS GROUP
—
Enumeration date
11/01/2006
Last updated
12/09/2008
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