Individual
SUSAN R WIERSMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
35-051050
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000027183
ANTHEM
OH
01
—
000000221140
UNISON
OH
01
—
000000526169
ANTHEM
OH
01
—
200206560A
OK MEDICAID
OK
01
—
2056126
BCMH
OH
05
—
2056126
—
OH
01
—
2093513
AETNA
OH
01
—
364131
WELLCARE
OH
01
—
742534
BUCKEYE
OH
Enumeration date
07/21/2006
Last updated
10/01/2008
Update your record
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