Provider Demographics
NPI:1508374372
Name:WIEHL, TEISHA MAUDREY
Entity Type:Individual
Prefix:
First Name:TEISHA
Middle Name:MAUDREY
Last Name:WIEHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24030
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:AK
Mailing Address - Zip Code:99724-0030
Mailing Address - Country:US
Mailing Address - Phone:907-628-6228
Mailing Address - Fax:907-628-6224
Practice Address - Street 1:1ST FRONT STREET
Practice Address - Street 2:30
Practice Address - City:BEAVER
Practice Address - State:AK
Practice Address - Zip Code:99724
Practice Address - Country:US
Practice Address - Phone:907-628-6228
Practice Address - Fax:907-628-6224
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker