Individual
MISS HALLIE CHANSON WIETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1123 N CHURCH ST, GREENSBORO, NC 27401-1007
(336) 832-4400
Mailing address
8165 WHITMORE COVE LN, CLEMMONS, NC 27012-8881
(336) 782-1405
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-08304
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010-08304
NORTH CAROLINA MEDICAL BOARD
NC
01
—
1152394
NCCPA
—
Enumeration date
08/27/2018
Last updated
08/27/2018
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