Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 61753 | AZ |
NPI | 1174633556 |
---|---|
Provider Name | Robert J Wiebers |
First Address | Phoenix, AZ 85013-3498 |
Second Address | Phoenix, AZ 85013-3498 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 26/10/2012 |