Individual
NICOLE WIEDEKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9041 NW 12TH COURT, PEMBROKE PINES, FL 33024
(954) 825-9281
Mailing address
9041 NW 12TH CT, PEMBROKE PINES, FL 33024-4626
(954) 825-9281
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA72749
FL
Other
Enumeration date
10/10/2016
Last updated
10/10/2016
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