Provider Demographics
NPI:1497337000
Name:WIELAND, JESSICA HELENA (RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:HELENA
Last Name:WIELAND
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 1:806 BUCKINGHAM CIR
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-2543
Mailing Address - Country:US
Mailing Address - Phone:414-399-3766
Mailing Address - Fax:
Practice Address - Street 1:N27W23960 PAUL RD
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-6218
Practice Address - Country:US
Practice Address - Phone:262-408-5873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251843163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse