Provider Demographics
NPI:1336037266
Name:WIESE, TEYLOR MCKAYLA (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:TEYLOR
Middle Name:MCKAYLA
Last Name:WIESE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:TEYLOR
Other - Middle Name:MCKAYLA
Other - Last Name:WIESE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:2564 NE COURTNEY DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7638
Mailing Address - Country:US
Mailing Address - Phone:541-678-5277
Mailing Address - Fax:
Practice Address - Street 1:2564 NE COURTNEY DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7638
Practice Address - Country:US
Practice Address - Phone:541-678-5277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10046316363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily