Individual
BETH LOUISE WIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
2500 NE NEFF RD, BEND, OR 97701-6015
(541) 382-4321
Mailing address
PO BOX 6095, BEND, OR 97708-6095
(541) 706-5922
(541) 706-6869
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
10005848
OR
363L00000X
Nurse Practitioner
201041547RN
OR
363LA2100X
Acute Care Nurse Practitioner
10005848
OR
363LG0600X
Gerontology Nurse Practitioner
10005848
OR
Other
Enumeration date
03/21/2023
Last updated
08/02/2023
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