MEDICARE: SUSAN WIEDEMANN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN215945	AZ

General Provider Information

NPI Number	:	1386593812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN WIEDEMANN

Provider Business Mailing Address
First Line	:	PO BOX 3212
Second Line	:
City	:	CAREFREE
State	:	AZ
Zip	:	85377-3212
Country	:	US
Telephone Number	:	757-777-2038
Fax Number	:	757-777-2038

Provider Business Practice Location Address
First Line	:	PO BOX 3212
Second Line	:
City	:	CAREFREE
State	:	AZ
Zip	:	85377-3212
Country	:	US
Telephone Number	:	757-777-2038
Fax Number	:	757-777-2038

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	01/27/2026

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Directions to “ SUSAN WIEDEMANN ” Practice Location

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