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General NPI Number Information
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NPI Number | 1174510457
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Entity Type | Organization
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Legal Business Name | PENNY A WESSON MD LLC
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Dates
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Enumeration Date | 10/03/2005
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Last Update Date | 07/09/2010
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Provider Practice Location Address
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Address Line | N34W28453 TAYLORS WOODS RD
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City | PEWAUKEE
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State | WI
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Zip | 53072-3365
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Country | US
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Telephone | 262-691-3430
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Fax |
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Provider Business Mailing Address
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Address Line | N34W28453 TAYLORS WOODS RD
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City | PEWAUKEE
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State | WI
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Zip | 53072-3365
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Country | US
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Telephone | 262-691-3430
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PENNY ANN WESSON
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Credential | MD
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Telephone | 262-691-3430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 46894020
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License Number State | WI
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