Healthcare Provider Details

I. General information

NPI: 1386682300
Provider Name (Legal Business Name): DEIRDRE FULLER WIESNER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 FARRINGTON CORNER RD
HOPKINTON NH
03229-2020
US

IV. Provider business mailing address

19 FARRINGTON CORNER RD
HOPKINTON NH
03229-2020
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-7575
  • Fax: 603-228-7585
Mailing address:
  • Phone: 603-228-7575
  • Fax: 603-228-7585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number344212303
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: