Individual
TANYA A WIESE
Active
Individual
TANYA A WIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
02002644A
IN
207RP1001X
Pulmonary Disease Physician
Primary
02781
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000290297
ANTHEM
KY
05
—
200456800
—
IN
05
—
64066590
—
KY
Enumeration date
07/07/2006
Last updated
04/12/2024
Update your record
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