Individual
TERESA L. WICZYNSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2780 E BARNETT RD STE 200, MEDFORD, OR 97504-8674
(541) 779-6250
(541) 608-2535
Mailing address
2780 E BARNETT RD STE 200, MEDFORD, OR 97504-8674
(541) 608-2569
(541) 608-2535
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA229908
OR
363A00000X
Physician Assistant
Primary
PA3248
KY
363A00000X
Physician Assistant
TC400
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/11/2023
Last updated
07/13/2026
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