Individual
MR. MICHAEL JAMES WIEDMEYER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
L.P.N.
Contact information
Practice address
820 DECKER DR, WEST BEND, WI 53090-2341
(262) 306-9815
Mailing address
820 DECKER DR, WEST BEND, WI 53090-2341
(262) 306-9815
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
33507-031
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38335700
—
WI
Enumeration date
05/01/2006
Last updated
07/09/2007
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