Individual
MICHAEL JON WIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
6161 S YALE AVE, TULSA, OK 74136-1902
(918) 494-0612
Mailing address
6839 S CANTON AVE, TULSA, OK 74136-3402
(918) 494-0612
(918) 481-5170
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
95192561
CA
163W00000X
Registered Nurse
R0110775
OK
367500000X
Certified Registered Nurse Anesthetist
Primary
214097
OK
Other
Enumeration date
04/12/2023
Last updated
07/28/2023
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