Individual
MRS. BETSY J WACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
1120 PINE ST, STANLEY, WI 54768-1297
(715) 644-5530
(715) 644-6223
Mailing address
1120 PINE ST, STANLEY, WI 54768-1297
(715) 644-5530
(715) 644-6223
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1206
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42989100
—
WI
Enumeration date
10/04/2006
Last updated
06/09/2010
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