Healthcare Provider Details

I. General information

NPI: 1689893018
Provider Name (Legal Business Name): VIKKI ANGERT WIENER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 05/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8340 COLLIER BLVD SUITE 204
NAPLES FL
34114-3625
US

IV. Provider business mailing address

8340 COLLIER BLVD SUITE 204
NAPLES FL
34114
US

V. Phone/Fax

Practice location:
  • Phone: 480-518-1776
  • Fax: 239-325-9045
Mailing address:
  • Phone: 239-354-4316
  • Fax: 239-354-4329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3007
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberOS-8610
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: