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General NPI Number Information
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NPI Number | 1972660124
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Entity Type | Individual
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Provider Name | DIANNE LYNNE WETTERSTEN PAC
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Gender | Female
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 700 CHIEF EDDIE HOFFMAN HWY YUKON-KUSKOKWIN HEALTH CORP
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City | BETHEL
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State | AK
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Zip | 99559
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Country | US
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Telephone | 907-543-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 411 OLD DEER PATH WAY
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City | CLEVELAND
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State | GA
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Zip | 30528-4245
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Country | US
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Telephone | 970-531-6736
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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 | 230955
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License Number State | AK
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