Individual
ELLIANA REGINA WIESNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
500 W 4TH ST, ODESSA, TX 79761
(432) 640-4000
(432) 640-4606
Mailing address
PO BOX 2129, ODESSA, TX 79760-2129
(432) 640-4000
(432) 640-4606
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
R4919
TX
208M00000X
Hospitalist Physician
R4919
TX
Other
Enumeration date
06/09/2015
Last updated
06/08/2018
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