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Individual
JANA G VAN WIE
Active
Individual
JANA G VAN WIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
2801-16706
NE
207Q00000X
Family Medicine Physician
Primary
16706
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
097552
GROUP PTAN
NE
01
—
097552008
PTAN
NE
05
—
10025894200
—
NE
01
—
1033117015
GROUP NPI
NE
01
—
1669781225
GROUP NPI
NE
01
—
1720062458
NPI
NE
01
—
248833
MIDLANDS CHOICE
NE
01
—
45359
BCBS
NE
01
—
6501500001
MEDICARE DME PTAN
NE
01
—
P00885788
RR MEDICARE
NE
Enumeration date
12/06/2005
Last updated
03/16/2017
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