Individual
DIANE M WIZEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
76 VETERANS AVE, BATH, NY 14810-0810
(607) 664-4000
Mailing address
253 E 2ND ST, CORNING, NY 14830-3301
(607) 936-0209
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
22 259 677
NY
Other
Enumeration date
08/31/2006
Last updated
07/08/2007
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