Individual
JENNIFER L WIEBKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
601 CHILDRENS LN, NORFOLK, VA 23507-1910
(757) 668-9466
(757) 668-7198
Mailing address
811 REDGATE AVE, NORFOLK, VA 23507-1515
(757) 668-7874
(757) 668-8658
Taxonomy
Speciality
Code
Description
License number
State
2080P0214X
Pediatric Pulmonology Physician
Primary
0101254409
VA
2080S0012X
Pediatric Sleep Medicine Physician
0101254409
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100177350
—
IN
05
—
1801861
—
LA
05
—
2655158
—
OH
Enumeration date
09/20/2006
Last updated
02/19/2019
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