Provider Demographics
NPI:1275872020
Name:WIEMAR, SUZANNE HURD
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:HURD
Last Name:WIEMAR
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 1:9241 S 71ST EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5383
Mailing Address - Country:US
Mailing Address - Phone:918-810-8850
Mailing Address - Fax:
Practice Address - Street 1:9241 S 71ST EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5383
Practice Address - Country:US
Practice Address - Phone:918-810-8850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker