Individual
TERESA L. WICZYNSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2933 BRECKENRIDGE LN STE 103, LOUISVILLE, KY 40220-1494
(502) 394-5678
Mailing address
2933 BRECKENRIDGE LN STE 103, LOUISVILLE, KY 40220-1494
(502) 394-5678
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA3248
KY
363A00000X
Physician Assistant
TC400
KY
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
05/11/2023
Last updated
09/25/2023
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