Basic Information
| Provider Information | |||||||||
| NPI: | 1245282284 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WIELAR | ||||||||
| FirstName: | AMY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 800778 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229080778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349240000 | ||||||||
| FaxNumber: | 4349242078 | ||||||||
| Practice Location | |||||||||
| Address1: | 4100 OLYMPIA CIR STE 201 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229113620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4342206620 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 10/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 0001138730 | VA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 367500000X | 174543 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | 0024168704 | VA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.