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General NPI Number Information
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NPI Number | 1831716828
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Entity Type | Individual
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Provider Name | MICHELE LEIGH WIECKOWSKI APRN
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Gender | Female
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Dates
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Enumeration Date | 06/25/2020
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Last Update Date | 09/23/2021
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Provider Practice Location Address
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Address Line | 440 FISCHER STORE RD
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City | WIMBERLEY
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State | TX
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Zip | 78676-6158
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Country | US
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Telephone | 844-767-9965
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Fax |
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Provider Business Mailing Address
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Address Line | 1203 DEEPWOODS TRL
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City | LEANDER
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State | TX
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Zip | 78641-8634
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Country | US
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Telephone | 512-762-6345
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 803210
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP1032763
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License Number State | TX
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