Individual
MR. JOHN WIEST JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
10100 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-8970
(503) 786-8435
Mailing address
9900 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-9777
(503) 571-8631
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
OR 078040891N1
OR
Other
Enumeration date
08/31/2006
Last updated
07/10/2007
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