Individual
JUDITH A. WIENKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1241 W STADIUM BLVD, JEFFERSON CITY, MO 65109-6023
(573) 635-5264
(573) 634-7423
Mailing address
PO BOX 104240, JEFFERSON CITY, MO 65110-4240
(573) 635-0234
(573) 634-7423
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
089694
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
215122
BCBS
MO
05
—
428553119
—
MO
01
—
752310
HEALTHLINK
MO
01
—
CD6058
RAILROAD GROUP
MO
01
—
P00222726
MEDICARE RAILROAD
MO
Enumeration date
01/31/2006
Last updated
01/09/2014
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