Individual
VICKI WIETING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
905 MAIN ST STE 204, KLAMATH FALLS, OR 97601-6066
(541) 591-6440
Mailing address
905 MAIN ST STE 204, KLAMATH FALLS, OR 97601-6066
(541) 591-6440
Taxonomy
Speciality
Code
Description
License number
State
246YR1600X
Registered Record Administrator
Primary
—
—
Other
Enumeration date
11/29/2022
Last updated
11/29/2022
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