| Doctor Name: | KAITLYN ELAINE WIELAND |
| NPI Number: | 1801142864 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | MA055609 |
| Business Practice Address: | 337 W Main St Suite 100 Leola, PA - 175402109 |
| Business Phone Number: | 7176566122 |
| Business Fax Number: | 7176560142 |
| Mailing Address: | 4131 Oregon Pike, Suite C EPHRATA |
| State: | PA |
| Postal Code: | 175229550 |
| Phone Number: | 7178595161 |
| Fax Number: | 7178595169 |
| NPI Enumeration Date: | 07/27/2012 |
| NPI Last Update Date: | 05/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | MA055609 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |