Healthcare Provider Details

I. General information

NPI: 1578498259
Provider Name (Legal Business Name): TAMMIE MARIE WIESNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 N MAIN ST
HOPE MILLS NC
28348-1833
US

IV. Provider business mailing address

409 LONDONDERRY DR
LUMBERTON NC
28358-8318
US

V. Phone/Fax

Practice location:
  • Phone: 910-491-2575
  • Fax:
Mailing address:
  • Phone: 910-674-1689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number23257
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: