Individual
MRS. AMY ANN WIEBUSCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
43 W PRAIRIE SHOPPING CTR, HAYDEN, ID 83835-9854
(208) 772-2774
Mailing address
30 HUNTER LN, CAMP HILL, PA 17011-2499
(800) 748-3243
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
58166
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
58166
RN
ID
Enumeration date
11/01/2021
Last updated
11/03/2021
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