Provider Demographics
NPI:1528537081
Name:WETZLER, MELIZA (MA)
Entity Type:Individual
Prefix:
First Name:MELIZA
Middle Name:
Last Name:WETZLER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 HIGH COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-9442
Mailing Address - Country:US
Mailing Address - Phone:707-237-1434
Mailing Address - Fax:
Practice Address - Street 1:140 E BROADWAY AVE STE B-13
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8632
Practice Address - Country:US
Practice Address - Phone:307-413-6528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty