Individual
VICKI LYNN WAEDEKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
144 E SUMMIT AVE, WALES, WI 53183-9546
(262) 968-6161
Mailing address
144 E SUMMIT AVE, WALES, WI 53183-9546
(262) 968-6161
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
923-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42981900
—
WI
Enumeration date
12/21/2005
Last updated
12/06/2021
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