Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 05969 | TX |
NPI | 1497825459 |
---|---|
Provider Name | Mr. William Michael Wueller |
First Address | Lavon, TX 75166-1840 |
Second Address | Rockwall, TX 75087-7317 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 22/01/2009 |