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General NPI Number Information
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NPI Number | 1245456862
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Entity Type | Individual
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Provider Name | TANIA RAE WIESELER PHARMD
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Gender | Female
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 07/29/2019
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Provider Practice Location Address
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Address Line | 410 S 5TH ST STE P1
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City | MANKATO
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State | MN
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Zip | 56001
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Country | US
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Telephone | 507-550-1063
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Fax | 507-625-7894
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Provider Business Mailing Address
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Address Line | 600 STATE ST N
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City | WASECA
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State | MN
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Zip | 56093-2814
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Country | US
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Telephone | 605-261-4933
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5270
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 120255
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License Number State | MN
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