Basic Information
| Provider Information | |||||||||
| NPI: | 1447270087 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WIERMAN | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | MAURA | ||||||||
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| Credential: | MD, FACP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3150 N TENAYA WAY | ||||||||
| Address2: | STE 200 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891280444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028222000 | ||||||||
| FaxNumber: | 7029382237 | ||||||||
| Practice Location | |||||||||
| Address1: | 3150 N TENAYA WAY | ||||||||
| Address2: | STE 200 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891280444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028222000 | ||||||||
| FaxNumber: | 7029382237 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 04/06/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 7788 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 32878 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | H9280 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 25112 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 002019840 | 05 | NV | MEDICAID |