Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1003423153 |
---|---|
Provider Name | Rochelle Wyche |
First Address | Kennesaw, GA 30152-6741 |
Second Address | Atlanta, GA 30342-2684 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2020 |
Last Update Date | 23/09/2020 |