Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | ARNP 1062972 | FL |
NPI | 1023067667 |
---|---|
Provider Name | Mr. Lance Webster Wegener |
First Address | New Port Richey, FL 34655-3600 |
Second Address | Port Richey, FL 34668 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 20/07/2018 |