Individual
DR. DAVID CHARLES WIESNER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Contact information
Practice address
2610 WYCLIFF RD, SUITE 103, RALEIGH, NC 27607-3073
(919) 782-4060
(919) 782-0906
Mailing address
8290 165TH AVE NE, REDMOND, WA 98052-3948
(425) 869-2644
(425) 867-0930
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
2039
NC
103T00000X
Psychologist
Primary
PY60405036
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04080
BC/BS PROVIDER NUMBER
NC
Enumeration date
01/09/2006
Last updated
03/12/2018
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