Individual
JORDAN WIEBE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
012361
AZ
2086S0122X
Plastic and Reconstructive Surgery Physician
80521
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/18/2019
Last updated
08/20/2026
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