Healthcare Provider Details

I. General information

NPI: 1114222940
Provider Name (Legal Business Name): ALISON LEE WIELAND PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 CREEKSTONE DR STE 250
DURHAM NC
27703-5430
US

IV. Provider business mailing address

1420 WHITTINGTON DR
RALEIGH NC
27614-8755
US

V. Phone/Fax

Practice location:
  • Phone: 610-704-9914
  • Fax:
Mailing address:
  • Phone: 610-704-9914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0010-08477
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00245800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: