Individual
WANDA L VANDERWYST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1818 N MEADE ST, APPLETON, WI 54911-3454
(920) 749-4000
(920) 749-4015
Mailing address
1818 N MEADE ST, APPLETON, WI 54911-3454
(920) 749-4000
(920) 749-4015
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
254
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42923600
—
WI
Enumeration date
03/05/2007
Last updated
07/08/2007
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