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TERESA J WIERSMA NP

Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1417931833

Individual Registrant:
 TERESA J WIERSMA NP
Gender: F
Not Sole Proprietor

Location and contact information for practice:
504 S HIGH ST  RANDOLPH, WI 53956-1499 US
Tel: 920-326-5060  Fax: --

Contact information for business:
504 S HIGH ST PO BOX 101 RANDOLPH, WI 53956-1499 US
Tel: 920-326-5060  Fax: --

Registration Information:
NPI: 1417931833
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LF0000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Family
WI125502

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
RAILROAD MEDICAREP00206887WI01
JOHN DEEREWI01S5WI01
DEAN13789WI01
UNITY390807236CWWI01
41253300WI05




HEALTH CARE JOBS WI - Page 1



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