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General NPI Number Information
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NPI Number | 1275088031
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Entity Type | Individual
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Provider Name | SHERMAN WAYNE WIENEKE AGNP
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Gender | Male
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Dates
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Enumeration Date | 08/22/2016
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Last Update Date | 01/10/2019
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Provider Practice Location Address
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Address Line | 4502 MEDICAL DR
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City | SAN ANTONIO
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State | TX
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Zip | 78229
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Country | US
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Telephone | 210-358-8555
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Fax | 210-358-8576
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Provider Business Mailing Address
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Address Line | 4502 MEDICAL DR
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4402
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Country | US
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Telephone | 210-358-8555
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Fax | 210-358-8576
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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 | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 0187139
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP131815
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License Number State | TX
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