Provider Demographics
NPI:1114050630
Name:WILEMAN, ROCHELLE M (PA)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:M
Last Name:WILEMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 W CALDWELL AVE
Mailing Address - Street 2:STE A
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-9224
Mailing Address - Country:US
Mailing Address - Phone:559-733-4505
Mailing Address - Fax:559-733-0876
Practice Address - Street 1:4025 W CALDWELL AVE
Practice Address - Street 2:STE A
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-9224
Practice Address - Country:US
Practice Address - Phone:559-733-4505
Practice Address - Fax:559-733-0876
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18324363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA18324OtherLICENSE