Individual
AMANDA WIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
150 MONUMENT RD STE 300, BALA CYNWYD, PA 19004-1725
(610) 747-3400
(610) 617-2481
Mailing address
150 MONUMENT RD STE 300, BALA CYNWYD, PA 19004-1725
(610) 747-3400
(610) 617-2481
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
SP026921
PA
363LG0600X
Gerontology Nurse Practitioner
SP026921
PA
Other
Enumeration date
03/22/2016
Last updated
05/09/2023
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