Individual provider · Type 1 NPI
Maria Theresa Liceralde Wyson, MSN, FNP-C
Family Nurse Practitioner · Elk Grove, CA
NPI number
1861769648
Active
Practice location
7811 Laguna Blvd Ste 161
Elk Grove, CA 95758-7949
Fax (916) 896-1286
Mailing address
11592 Linday Way
Gold River, CA 95670-6233
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Nurse Practitioner Primary | 363LF0000X | 21360 (CA) |
Family Nurse Practitioner: Definition to come...
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About NPI 1861769648
Maria Theresa Liceralde Wyson, MSN, FNP-C's National Provider Identifier is 1861769648, issued on Nov 22, 2011. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Elk Grove, CA. The record was last updated on Mar 7, 2023.