MEDICARE: AMELIA RUTH WIEAND R.N.

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	163W00000X	Registered Nurse	RN0000159171	TN

General Provider Information

NPI Number	:	1780914846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMELIA RUTH WIEAND R.N.

Provider Business Mailing Address
First Line	:	4040 MOUNTAIN CREEK RD
Second Line	:	APT # 2301
City	:	CHATTANOOGA
State	:	TN
Zip	:	37415-6034
Country	:	US
Telephone Number	:	423-475-5696
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 RIVERSIDE DR
Second Line	:	SUITE 120
City	:	CHATTANOOGA
State	:	TN
Zip	:	37406-4309
Country	:	US
Telephone Number	:	423-634-3110
Fax Number	:	423-634-5848

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

Provider Enumeration Date	:	01/12/2010
Last Update Date	:	01/12/2010

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