Individual
MATTHEW CLAUDE WIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
10085 DOUBLE R BLVD STE 220, RENO, NV 89521-3855
(775) 982-5000
(775) 982-3900
Mailing address
1155 MILL ST MS M14, RENO, NV 89502-1576
(775) 982-5262
(775) 982-3900
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA986
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124035910
—
NV
01
—
13245768
CAQH
—
Enumeration date
08/02/2006
Last updated
05/13/2021
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