Provider Demographics
NPI:1376729111
Name:WIEJSKI, ANETA (MD)
Entity Type:Individual
Prefix:
First Name:ANETA
Middle Name:
Last Name:WIEJSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 N DYSART RD
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-1213
Mailing Address - Country:US
Mailing Address - Phone:623-232-3322
Mailing Address - Fax:
Practice Address - Street 1:1719 N DYSART RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-1213
Practice Address - Country:US
Practice Address - Phone:623-232-3322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42337207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ81047OtherTRAINING PERMIT
AZ448567Medicaid
AZ81047OtherTRAINING PERMIT
AZZ134146Medicare PIN