Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 243431 | NY |
N | 111NI0900X | Internist | 243431 | NY |
N | 207RA0401X | Internist - Addiction Medicine | 33843 | MN |
NPI | 1114965597 |
---|---|
Provider Name | Dr. Kathleen M Wesa |
First Address | Middletown, NY 10940-2650 |
Second Address | Harris, NY 12742 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2006 |
Last Update Date | 17/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03616346 | (05) | NY |
495772500 | (05) | MN |
F35701 | (02) |