Individual
CARSTEN WIEMKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-2111
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 215-9704
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
602897
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0033169-02
—
TX
01
—
84445U
BLUE SHIELD
TX
01
—
P00246075
RR/MEDICARE
TX
Enumeration date
04/05/2006
Last updated
12/13/2022
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