Basic Information
| Provider Information | |||||||||
| NPI: | 1720296361 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WIESNER | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | JOSEPHINE | ||||||||
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| Credential: | B.A.N, R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 955 POWELL AVE SW | ||||||||
| Address2: | SUITE A | ||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980552908 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 126 AUBURN AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | AUBURN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980025057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537350166 | ||||||||
| FaxNumber: | 2538338987 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 163WC1500X | RN00094069 | WA | Y | Nursing Service Providers | Registered Nurse | Community Health |
No ID Information.