Wiese, Kathleen Marie

Wiese, Kathleen Marie is an individual health care provider with primary practice located at 3333 Silas Creek Pkwy , Winston Salem NC 27103-3013. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Vascular Neurology, Allopathic & Osteopathic Physicians / Neurology. Allopathic & Osteopathic Physicians / Neurology is her primary health care specialty. Wiese, Kathleen Marie can be contacted via phone (336) 718-7597.

Contact Information

Primary practice address
3333 Silas Creek Pkwy Winston Salem NC 27103-3013
Fax: (336) 718-7598
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Vascular Neurology 2084V0102X 2007-01475 North Carolina
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 2007-01475 North Carolina

Profile Details

NPI number 1790987923
LBN Legal business name Wiese, Kathleen Marie
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 1st, 2007
Last updated Oct 25th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790987923 NPPES
North Carolina Other 2007-01475 NC MED BOARD LICENSE
North Carolina MEDICAID 5907596 NC MED BOARD LICENSE
North Carolina Other 1457P NC MED BOARD LICENSE
North Carolina Other P00414192 NC MED BOARD LICENSE

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