Doctor Name: | RACHEL WIEBERG |
NPI Number: | 1043606627 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 2015010645 |
Business Practice Address: | 1241 W Stadium Blvd Jefferson City, MO - 651096023 |
Business Phone Number: | 5736355264 |
Business Fax Number: | |
Mailing Address: | Po Box 104240, JEFFERSON CITY |
State: | MO |
Postal Code: | 651104240 |
Phone Number: | 5736255264 |
Fax Number: | |
NPI Enumeration Date: | 04/10/2015 |
NPI Last Update Date: | 04/10/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 2015010645 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |