Individual
PATRICIA A WUNDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3011 S TAGISH WAY, MERIDIAN, ID 83642-9157
(208) 283-9398
(208) 288-2535
Mailing address
3011 S TAGISH WAY, MERIDIAN, ID 83642-9157
(208) 283-9398
(208) 288-2535
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
00F570
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00F570
CERTIFIED FIRST ASSISTANT
ID
Enumeration date
12/18/2006
Last updated
07/08/2007
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