Healthcare Provider Details

I. General information

NPI: 1346957255
Provider Name (Legal Business Name): DANA HILARY WIESENFELD FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 08/23/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 REGENT ST STE 200
COLUMBUS OH
43219-6229
US

IV. Provider business mailing address

3140 ARBORWOODS DR
ALPHARETTA GA
30022-5289
US

V. Phone/Fax

Practice location:
  • Phone: 877-870-1775
  • Fax: 149-688-8406
Mailing address:
  • Phone: 404-642-5336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN264559
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: