Individual
DR. GLENN A WIENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2430 20TH ST SW, JAMESTOWN, ND 58401-6201
(701) 253-5300
(701) 253-5402
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(701) 253-5300
(701) 253-5402
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5541
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14061
BLUE CROSS OF ND
ND
05
—
1450684
—
ND
05
—
16326
—
ND
Enumeration date
07/11/2006
Last updated
12/23/2015
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