Individual
MICAH WIESNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
712A SAINT JOHN ST, GARDEN CITY, KS 67846-5128
(620) 275-1766
(620) 275-4729
Mailing address
712 SAINT JOHN ST, GARDEN CITY, KS 67846-5128
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
05/02/2016
Last updated
03/09/2020
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