Provider Demographics
NPI:1235996067
Name:WIANS, TERI (LIC ELECTROLOGIST)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:WIANS
Suffix:
Gender:F
Credentials:LIC ELECTROLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6510 GRAND TETON PLZ STE 412
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1029
Mailing Address - Country:US
Mailing Address - Phone:608-203-6211
Mailing Address - Fax:
Practice Address - Street 1:6510 GRAND TETON PLZ STE 412
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1029
Practice Address - Country:US
Practice Address - Phone:608-203-6211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI174400000X
WI733-84174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist