Gina Wiesbrock ATC

NPI 1033241807 - Specialist/Technologist - 2255A2300X

NPI Details
NPI 1033241807
Gender Female
Enumeration Date 03/09/2007
Last Updated 07/08/2007
Entity Type Individual
Active Over 9 years ago
Practice Location
1627 4TH ST
PERU IL, 61354-3507, US
Phone (815) 228-7939
Fax
Business Location
2227 STATE ST
PERU IL, 61354-3465, US
Phone (815) 228-7939
Fax
Toxanomy
Taxonomy Code 2255A2300X
License State Illinois
License Number 96001397
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According to our database, Gina Wiesbrock ATC NPI is 1033241807, taxonomy code is 2255A2300X and license number is 96001397, license state is located at Illinois. Gina Wiesbrock ATC physically located at 1627 4th St, Peru IL, 61354-3507. NPI Number Gina Wiesbrock ATC has the Individual type.

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1033241807 NPI number is provided on an as is basis without warranty of any kind. 1033241807 is maintained by the National Plan & Provider Enumeration System. The contents of Gina Wiesbrock ATC are for informational purposes only.