| Doctor Name: | DR. TARRA WASILCHEN |
| NPI Number: | 1518231968 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 27812 |
| Business Practice Address: | 2200 Bergquist Dr Suite 1 Lackland A F B, TX - 782365300 |
| Business Phone Number: | 2402817782 |
| Business Fax Number: | |
| Mailing Address: | 2200 Bergquist Dr, Suite 1 LACKLAND A F B |
| State: | TX |
| Postal Code: | 782369907 |
| Phone Number: | 2402817782 |
| Fax Number: | |
| NPI Enumeration Date: | 03/02/2012 |
| NPI Last Update Date: | 04/25/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 27812 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NE |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |