Individual
REBECCA WIESNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
1379 ENFIELD ST, ENFIELD, CT 06082-5524
(860) 741-3041
(860) 741-5644
Mailing address
1379 ENFIELD ST, ENFIELD, CT 06082-5524
(860) 741-3041
(860) 741-5644
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
2228
TX
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
926
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/12/2012
Last updated
06/23/2021
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