Provider Demographics
NPI:1548545189
Name:ESIANOR, EMMANUEL (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:
Last Name:ESIANOR
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 WESTHILL DR
Mailing Address - Street 2:STE 200
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-3771
Mailing Address - Country:US
Mailing Address - Phone:715-843-1000
Mailing Address - Fax:715-843-1001
Practice Address - Street 1:2800 WESTHILL DR
Practice Address - Street 2:STE 200
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-3771
Practice Address - Country:US
Practice Address - Phone:715-843-1000
Practice Address - Fax:715-843-1001
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI3086-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3086-23OtherLICENSE