Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | C164329 | IA |
NPI | 1023688215 |
---|---|
Provider Name | Jordyn Lee Wiser |
First Address | Ankeny, IA 50023-7305 |
Second Address | Ankeny, IA 50023-7305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2021 |
Last Update Date | 29/06/2021 |