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Individual

WILLIAM WIETIES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
300 W 27TH ST, LUMBERTON, NC 28358-3075
(910) 671-5000
(910) 738-3764
Mailing address
2600 N ELM ST, LUMBERTON, NC 28358-3011
(910) 671-5290
(910) 738-3764

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
102562
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1104958412
NC
05
913284816
MO
Enumeration date
03/12/2007
Last updated
04/10/2025
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