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General NPI Number Information
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NPI Number | 1235291394
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Entity Type | Individual
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Provider Name | WIETSKE WILLEMSMA MOORE CFNP
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Gender | Female
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 09/06/2011
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Provider Practice Location Address
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Address Line | 3020 14TH ST NW
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City | WASHINGTON
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State | DC
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Zip | 20009-6865
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Country | US
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Telephone | 202-745-4300
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Fax | 202-745-5907
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Provider Business Mailing Address
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Address Line | 12548 MOUNTAIN RD
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City | LOVETTSVILLE
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State | VA
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Zip | 20180-2609
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Country | US
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Telephone | 703-554-4527
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN966736
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License Number State | DC
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