Provider Demographics
NPI:1467709154
Name:WIEMANN, LIVIA MONA (RN)
Entity Type:Individual
Prefix:
First Name:LIVIA
Middle Name:MONA
Last Name:WIEMANN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 BROADWAY DR
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-1090
Mailing Address - Country:US
Mailing Address - Phone:608-358-8191
Mailing Address - Fax:
Practice Address - Street 1:4391 PARKLAWN DR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:WI
Practice Address - Zip Code:53598-9788
Practice Address - Country:US
Practice Address - Phone:608-572-0304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI158884-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse