Individual
CAROL MICHELLE WIESNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2000 COOPER ST STE 120, FORT WORTH, TX 76104-2535
(817) 820-2890
(817) 810-0725
Mailing address
2000 COOPER ST STE 120, FORT WORTH, TX 76104-2535
(817) 820-2890
(817) 810-0725
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1154625
TX
Other
Enumeration date
11/13/2023
Last updated
10/02/2024
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