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NPI Code Detail

MEDICARE: MR. DAVID WIEBE RN

MEDICARE: MR. DAVID WIEBE RN
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
1163WE0003XEmergency Registered Nurse550374CA

General Provider Information

NPI Number : 1528853868
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID WIEBE RN
Provider Business Mailing Address
First Line : 315 N SANTA ANA AVE
Second Line :
City : MODESTO
State : CA
Zip : 95354-1552
Country : US
Telephone Number : 831-295-0960
Fax Number :
Provider Business Practice Location Address
First Line : 315 N SANTA ANA AVE
Second Line :
City : MODESTO
State : CA
Zip : 95354-1552
Country : US
Telephone Number : 831-295-0960
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2025
Last Update Date : 04/09/2025

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