Healthcare Provider Details

I. General information

NPI: 1962848085
Provider Name (Legal Business Name): BRANDI WIENS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 E CENTRAL AVE
ANDOVER KS
67002-5605
US

IV. Provider business mailing address

2700 E 30TH AVE
HUTCHINSON KS
67502-1242
US

V. Phone/Fax

Practice location:
  • Phone: 316-733-1331
  • Fax: 316-733-4916
Mailing address:
  • Phone: 620-663-8484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9408117
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number04-39185
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: