Individual
MR. JEFFREY PAUL WIENCEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
3723 FRANKLIN ST, MICHIGAN CITY, IN 46360-7310
(219) 874-3313
(219) 878-2330
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71000502A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
71000502A
LICENSE IN
IN
Enumeration date
12/14/2005
Last updated
09/28/2023
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