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General NPI Number Information
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NPI Number | 1548913304
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Entity Type | Individual
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Provider Name | ALISON MARIE WIETHE PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/01/2022
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 1 WYOMING ST
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City | DAYTON
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State | OH
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Zip | 45409-2711
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Country | US
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Telephone | 939-208-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 714 RESIDENZ PKWY APT C
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City | DAYTON
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State | OH
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Zip | 45429-6215
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Country | US
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Telephone | 513-846-4171
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.007453RX
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License Number State | OH
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