Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 2020024093 | MO |
NPI | 1144563230 |
---|---|
Provider Name | Dr. Anne Elizabeth Wyman |
First Address | Saint Louis, MO 63128-2106 |
Second Address | Saint Louis, MO 63128-2106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2013 |
Last Update Date | 26/08/2020 |