Individual
LISA NICOLE WACKERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
6986 SCOTT RD, MARIPOSA, CA 95338-9639
(209) 966-7095
Mailing address
PO BOX 2308, MARIPOSA, CA 95338-2308
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
Primary
RN95201290
CA
Other
Enumeration date
07/31/2020
Last updated
07/31/2020
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