Individual
ALLICEN MARIE WAXLAX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
81051
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/05/2021
Last updated
02/15/2024
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