Individual
EMILY WIETING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-5200
(414) 259-0469
Mailing address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-5200
(414) 259-0469
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3814-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891147021
—
WI
Enumeration date
07/12/2016
Last updated
07/21/2022
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