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TERESA J WIERSMA NP
Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1417931833
Individual Registrant: TERESA J WIERSMA NP
Gender: F
Not Sole Proprietor
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: --
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: --
Tel: 920-326-5060 Fax: --
Registration Information:
NPI: 1417931833
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Family | WI | 125502 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| RAILROAD MEDICARE | P00206887 | WI | 01 |
| JOHN DEERE | WI01S5 | WI | 01 |
| DEAN | 13789 | WI | 01 |
| UNITY | 390807236CW | WI | 01 |
| 41253300 | WI | 05 |
