MEDICARE: HEATHER WIESE DNP, PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	111888	NE

General Provider Information

NPI Number	:	1578930376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER WIESE DNP, PMHNP-BC

Provider Business Mailing Address
First Line	:	8550 CUTHILLS CIR STE 100
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68526-9523
Country	:	US
Telephone Number	:	402-476-6060
Fax Number	:	402-476-6809

Provider Business Practice Location Address
First Line	:	2301 O ST
Second Line	:
City	:	LINCOLN
State	:	NE
Zip	:	68510-1124
Country	:	US
Telephone Number	:	402-342-7038
Fax Number	:

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

Provider Enumeration Date	:	08/27/2015
Last Update Date	:	02/15/2024

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