Provider Demographics
NPI:1003201765
Name:WIEBE, PARKER HURST
Entity Type:Individual
Prefix:
First Name:PARKER
Middle Name:HURST
Last Name:WIEBE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 PHYSICIANS DR
Mailing Address - Street 2:UNIT 104
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7361
Mailing Address - Country:US
Mailing Address - Phone:910-343-6890
Mailing Address - Fax:
Practice Address - Street 1:1606 PHYSICIANS DR
Practice Address - Street 2:UNIT 104
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7361
Practice Address - Country:US
Practice Address - Phone:910-343-6890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist