Individual
MS. JENNIFER KAY WIELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
615 23RD AVE STE 200, FAIRBANKS, AK 99701-7041
(907) 455-9737
Mailing address
PO BOX 82074, FAIRBANKS, AK 99708-2074
(907) 455-9737
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CM4583
—
AK
Enumeration date
11/27/2007
Last updated
11/27/2007
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