Individual
NICHOLAS M WETJEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
815 SW BOND ST, BEND, OR 97702-3593
(541) 382-4900
Mailing address
815 SW BOND ST, BEND, OR 97702-3593
(541) 382-4900
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
01087764A
IN
207T00000X
Neurological Surgery Physician
43826
MN
207T00000X
Neurological Surgery Physician
Primary
MD-45106
IA
207T00000X
Neurological Surgery Physician
Primary
MD226031
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1102242609
ANTHEM PTAN
IN
05
—
300062435
—
IN
05
—
500865539
—
OR
01
—
IN4866038
MEDICARE PTAN
IN
01
—
R278555
MEDICARE
OR
Enumeration date
03/16/2006
Last updated
01/24/2026
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