Healthcare Provider Details

I. General information

NPI: 1588989917
Provider Name (Legal Business Name): SHERON LORRAINE WIESS R.N. C.D.E.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 S SHACKLEFORD RD
LITTLE ROCK AR
72211-4335
US

IV. Provider business mailing address

4703 RIDGE RD
NORTH LITTLE ROCK AR
72116-7108
US

V. Phone/Fax

Practice location:
  • Phone: 501-219-7281
  • Fax: 501-219-7909
Mailing address:
  • Phone: 501-291-7281
  • Fax: 501-219-7909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberR44528
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: