Individual
LISA VAN WIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1375 WASHINGTON AVE STE 201, ALBANY, NY 12206-1056
(518) 533-3420
Mailing address
1375 WASHINGTON AVE STE 201, ALBANY, NY 12206-1056
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
462362
NY
Other
Enumeration date
12/15/2021
Last updated
12/15/2021
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