Individual
CHANNING C WIERSEMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2401 PLOVER RD, PLOVER, WI 54467-3916
(715) 295-3800
Mailing address
900 ILLINOIS AVE, STEVENS POINT, WI 54481-3114
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
38945
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32381800
—
WI
Enumeration date
12/22/2006
Last updated
05/27/2008
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