Healthcare Provider Details

I. General information

NPI: 1720671191
Provider Name (Legal Business Name): KARY WIESLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 N 46TH ST
MILWAUKEE WI
53208-2740
US

IV. Provider business mailing address

1209 N 46TH ST
MILWAUKEE WI
53208-2740
US

V. Phone/Fax

Practice location:
  • Phone: 414-416-3354
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number66301-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: