Individual
NANCY WIEBKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
THREE ST. ELIZABETH'S BLVD., STE. 2800, O'FALLON, IL 62269-1099
(618) 233-6044
(833) 973-4218
Mailing address
THREE ST. ELIZABETH'S BLVD., STE. 2800, O'FALLON, IL 62269-1099
(618) 233-6044
(833) 973-4218
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
209.000757
IL
363LA2200X
Adult Health Nurse Practitioner
Primary
209000757
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101174
HEALTH ALLIANCE
—
01
—
478882
HEALTHLINK
—
01
—
500020298
RR MEDICARE
—
01
—
P38294
MERCY
—
Enumeration date
06/19/2006
Last updated
03/17/2020
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