Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 62088-20 | WI |
N | 207ND0101X | MOHS-Micrographic Surgeon | 62088-20 | WI |
N | 207R00000X | Internist | 27119 | OK |
N | 111NI0900X | Internist | 27119 | OK |
NPI | 1043445620 |
---|---|
Provider Name | Aelayna Meyer |
First Address | Manitowoc, WI 54220-4630 |
Second Address | Wausau, WI 54401-4200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2009 |
Last Update Date | 23/02/2021 |