Individual
BRADLEY A WIESNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
900 LINCOLN AVE, GRANT, NE 69140-3095
(308) 352-7200
(308) 352-7290
Mailing address
900 LINCOLN AVE, GRANT, NE 69140-3095
(308) 352-7200
(308) 352-7290
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
101208
NE
367500000X
Certified Registered Nurse Anesthetist
R 179376-9
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025589400
—
NE
Enumeration date
12/21/2012
Last updated
12/21/2018
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