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Individual

MRS. MIKAYLA D WIESE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
715 N SAINT JOSEPH AVE, HASTINGS, NE 68901-4451
(402) 461-4521
Mailing address
715 N SAINT JOSEPH AVE, HASTINGS, NE 68901-4451

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2090
NE

Other

Enumeration date
01/25/2017
Last updated
01/25/2017
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