Provider Demographics
NPI:1003438979
Name:WEHMANEN, FANIE
Entity Type:Individual
Prefix:
First Name:FANIE
Middle Name:
Last Name:WEHMANEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3364 RIDGE MANOR WAY
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-2728
Mailing Address - Country:US
Mailing Address - Phone:561-859-4172
Mailing Address - Fax:
Practice Address - Street 1:240 MITCHELL BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2043
Practice Address - Country:US
Practice Address - Phone:706-612-6995
Practice Address - Fax:706-369-6328
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN273751163WE0003X, 163WP0809X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult