Individual
CODY WIENCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 NE 87TH AVE, VANCOUVER, WA 98664-4896
(360) 882-2778
Mailing address
PO BOX 4825, PORTLAND, OR 97208-4825
(360) 882-2778
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD61302171
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/25/2019
Last updated
03/29/2023
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