MEDICARE: MEGAN MARY WIESEL PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA850	NV

General Provider Information

NPI Number	:	1528060225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN MARY WIESEL PA-C

Provider Business Mailing Address
First Line	:	9780 W SKYE CANYON PARK DR STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-6625
Country	:	US
Telephone Number	:	702-589-3100
Fax Number	:	702-851-7725

Provider Business Practice Location Address
First Line	:	9780 W SKYE CANYON PARK DR STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-6625
Country	:	US
Telephone Number	:	702-589-3100
Fax Number	:	702-851-7725

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	06/07/2023

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