Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 9440 | MN |
NPI | 1043386345 |
---|---|
Provider Name | Dr. Carlin Lee Wiemers |
First Address | Mankato, MN 56001-3501 |
Second Address | Mankato, MN 56001-3501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 08/07/2007 |