Individual
ELISE R WIESNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
500 E ROBINSON ST STE 2400, NORMAN, OK 73071-6684
(405) 515-0380
(405) 307-5632
Mailing address
PO BOX 1330, NORMAN, OK 73070-1330
(405) 307-6630
(405) 307-6660
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
18219
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100826940A
—
OK
Enumeration date
11/15/2005
Last updated
06/23/2021
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