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Individual

IDALUPE WISHON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PAC

Contact information

Practice address
2833 ALAN A DL, IRVING, TX 75061-6422
(972) 342-6253
Mailing address
2833 ALAN A DL, IRVING, TX 75061-6422

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA02452
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2052045-01
TX
01
PA02452
MEDICAL LICENSE- PAC
TX
Enumeration date
08/05/2007
Last updated
04/22/2026
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