Most Relevant Information
Provider Data
| NPI Number: | 1003540220 |
| Provider Name: | GAYANA WANNIARACHCHI |
| Entity Type: | Individual |
| Taxonomy Code: | 213ES0103X |
| Specialty: | Podiatrist |
| License Number: | 135.001170 |
Most Important Dates
| Enumeration Date: | 07/13/2022 |
| Last Updated: | 07/13/2022 |
Provider Practice Location
215 E 1ST ST STE 111
DIXON
IL
610213198
Practice Location Phone/Fax
| Phone: | 8153455677 |
| Fax: |
Provider Mailing Location
215 E 1ST ST STE 111
DIXON
IL
610213198
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |
Suggested EMR
Podiatry EMR