Individual
MS. ANDREA BENNETT WIESER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2401 GILLHAM RD, KANSAS CITY, MO 64108-4619
(816) 234-3000
(816) 302-9939
Mailing address
2401 GILLHAM RD, PROVIDER ENROLLMENT, KANSAS CITY, MO 64108-4619
(816) 701-5200
(816) 302-9939
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2011003921
MO
363A00000X
Physician Assistant
—
VA
Other
Enumeration date
01/30/2008
Last updated
05/11/2018
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