Individual
JASON WIELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3000 NEW BERN AVE, RALEIGH, NC 27610-1231
(919) 350-8000
Mailing address
1420 WHITTINGTON DR, RALEIGH, NC 27614-8755
(631) 896-8293
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-08469
NC
363AM0700X
Medical Physician Assistant
Primary
0010-08469
NC
363AS0400X
Surgical Physician Assistant
016379
NY
Other
Enumeration date
02/04/2013
Last updated
11/20/2024
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