Individual
MRS. JILL ELIZABETH WIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, NNP-BC
Contact information
Practice address
19600 E 39TH ST S, ATTN: NICU, INDEPENDENCE, MO 64057-2301
(816) 698-7340
Mailing address
19600 E 39TH ST S, ATTN: NICU, INDEPENDENCE, MO 64057-2301
(816) 698-7340
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
2010028802
MO
Other
Enumeration date
08/24/2010
Last updated
08/24/2010
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