Healthcare Provider Details

I. General information

NPI: 1033991823
Provider Name (Legal Business Name): BRIANNE WIENER HAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 N MAIN ST
DELPHOS OH
45833-1767
US

IV. Provider business mailing address

248 N MAIN ST
DELPHOS OH
45833-1767
US

V. Phone/Fax

Practice location:
  • Phone: 419-692-7600
  • Fax:
Mailing address:
  • Phone: 419-692-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberIL.03493
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: