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NPI Code Detail

MEDICARE: DR. JULIE A. WIESE M.D.

MEDICARE: DR. JULIE A. WIESE M.D.
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
12084P0800XPsychiatry Physician3090271205UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1292740OTHERUTDESERET MUTUAL
2346475OTHERUTUNKNOWN CARRIER
3942938348W11OTHERUTEDUCATORS MUTUAL
410700772D103OTHERUTINTRMTN. HEALTH CARE

General Provider Information

NPI Number : 1417931296
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JULIE A. WIESE M.D.
Provider Business Mailing Address
First Line : 934 S MAIN ST
Second Line :
City : LAYTON
State : UT
Zip : 84041-7135
Country : US
Telephone Number : 801-773-7060
Fax Number :
Provider Business Practice Location Address
First Line : 934 S MAIN ST
Second Line :
City : LAYTON
State : UT
Zip : 84041-7135
Country : US
Telephone Number : 801-773-7060
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2005
Last Update Date : 08/05/2013

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