Individual
MARY ANN WIETBROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN MSN ACNS-BC
Contact information
Practice address
102 GRANBY DR, CUMBERLAND, IN 46229-4203
(317) 410-9140
(317) 861-1556
Mailing address
4108 W 400 S, NEW PALESTINE, IN 46163-9612
(317) 410-9140
Taxonomy
Speciality
Code
Description
License number
State
364S00000X
Clinical Nurse Specialist
Primary
28088637A
IN
Other
Enumeration date
05/28/2014
Last updated
10/17/2024
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