Individual
MS. MICRALYN DENEE WIECHMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, FNP-C, ENP-C
Contact information
Practice address
25A JUNE ST, SANFORD, ME 04073-2642
(207) 490-7900
Mailing address
25A JUNE ST, SANFORD, ME 04073-2642
(207) 490-7900
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP141132
TX
363LF0000X
Family Nurse Practitioner
Primary
AP141132
TX
363LF0000X
Family Nurse Practitioner
CNP211033
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013562685
—
TX
Enumeration date
08/09/2019
Last updated
08/26/2021
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