Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 2012020336 | MO |
NPI | 1003171968 |
---|---|
Provider Name | Brianne Leigh Wehner |
First Address | Kirksville, MO 63501-6401 |
Second Address | Kirksville, MO 63501-6401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2012 |
Last Update Date | 06/07/2012 |