Individual
TERESA J WIERSMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
504 S HIGH ST, RANDOLPH, WI 53956-1499
(920) 326-5060
Mailing address
504 S HIGH ST, PO BOX 101, RANDOLPH, WI 53956-1499
(920) 326-5060
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
125502
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13789
DEAN
WI
01
—
390807236CW
UNITY
WI
05
—
41253300
—
WI
01
—
P00206887
RAILROAD MEDICARE
WI
01
—
WI01S5
JOHN DEERE
WI
Enumeration date
11/30/2005
Last updated
09/15/2016
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