Provider Demographics
NPI:1467821116
Name:WETRICH, BRIANA (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:WETRICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 E 11TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-4300
Mailing Address - Country:US
Mailing Address - Phone:712-264-3500
Mailing Address - Fax:712-264-3525
Practice Address - Street 1:116 E 11TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4300
Practice Address - Country:US
Practice Address - Phone:712-264-3500
Practice Address - Fax:712-264-3525
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079193363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant