Individual
MICHAEL JON WIESE
Active
Individual
MICHAEL JON WIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
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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