Individual
JONATHAN WIELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
18701 N 67TH AVE, GLENDALE, AZ 85308-7100
(623) 561-1000
Mailing address
9842 W PONTIAC DR, PEORIA, AZ 85382-2277
(623) 374-6508
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP11800
AZ
Other
Enumeration date
12/10/2018
Last updated
12/10/2018
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