Healthcare Provider Details

I. General information

NPI: 1245282284
Provider Name (Legal Business Name): AMY BURDICK WIELAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 OLYMPIA CIR STE 201
CHARLOTTESVILLE VA
22911-3620
US

IV. Provider business mailing address

PO BOX 800778
CHARLOTTESVILLE VA
22908-0778
US

V. Phone/Fax

Practice location:
  • Phone: 434-220-6620
  • Fax:
Mailing address:
  • Phone: 434-924-0000
  • Fax: 434-924-2078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number273
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: