Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224P00000X | Prosthetist |
NPI | 1215079181 |
---|---|
Provider Name | Susan Wisla |
First Address | East Meadow, NY 11554-5410 |
Second Address | East Meadow, NY 11554-5410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 21/10/2012 |