=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740426972
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE CHERIE WIENEKE APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2008
-----------------------------------------------------
Last Update Date | 09/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16312 GRACKLE DR
-----------------------------------------------------
City | ROGERS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72756-7742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-481-6599
-----------------------------------------------------
Fax | 479-413-8927
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16312 GRACKLE DR
-----------------------------------------------------
City | ROGERS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72756-7742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-481-6599
-----------------------------------------------------
Fax | 479-413-8927
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | A03213
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | ATP000182
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------