Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 4852-12 | WI |
NPI | 1285908566 |
---|---|
Provider Name | Alia Hussain |
First Address | Wausau, WI 54401-3958 |
Second Address | Wausau, WI 54401-4919 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2012 |
Last Update Date | 03/03/2012 |