Provider Demographics
NPI:1467654665
Name:WIESNER, AMY (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:WIESNER
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WESTPORT AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-3914
Mailing Address - Country:US
Mailing Address - Phone:203-962-5887
Mailing Address - Fax:203-847-2739
Practice Address - Street 1:1 WESTPORT AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-3914
Practice Address - Country:US
Practice Address - Phone:203-962-5887
Practice Address - Fax:203-847-2739
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000302171100000X
CT000278175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered175F00000XOther Service ProvidersNaturopath