Healthcare Provider Details

I. General information

NPI: 1780914846
Provider Name (Legal Business Name): AMELIA RUTH WIEAND R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 RIVERSIDE DR SUITE 120
CHATTANOOGA TN
37406-4309
US

IV. Provider business mailing address

4040 MOUNTAIN CREEK RD APT # 2301
CHATTANOOGA TN
37415-6034
US

V. Phone/Fax

Practice location:
  • Phone: 423-634-3110
  • Fax: 423-634-5848
Mailing address:
  • Phone: 423-475-5696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000159171
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: