Individual
GERALD CARL WIEDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4130 SW 325TH ST, FEDERAL WAY, WA 98023-2427
(206) 234-8384
Mailing address
4130 SW 325TH ST, FEDERAL WAY, WA 98023-2427
(206) 234-8384
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN00132339
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05
—
WA
Enumeration date
08/23/2018
Last updated
08/23/2018
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