Individual
KATELYN WYETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
701 E 17TH ST, BLOOMINGTON, IN 47408-1578
(812) 855-1966
Mailing address
400 E MELROSE AVE, BLOOMINGTON, IN 47401-1904
(630) 414-2408
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/02/2023
Last updated
01/02/2023
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