Individual
KATIE LYNN WYSOCKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
140 HOSPITAL DR STE 108, BENNINGTON, VT 05201-5010
(802) 447-5519
Mailing address
140 HOSPITAL DR, BENNINGTON, VT 05201-5009
(802) 447-5519
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0550031179
VT
363AM0700X
Medical Physician Assistant
PA100218
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03349671
—
NY
Enumeration date
07/08/2010
Last updated
02/20/2024
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