Provider Demographics
NPI:1508909607
Name:WIEST, PAUL DANIEL (PA (ASCP))
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:DANIEL
Last Name:WIEST
Suffix:
Gender:M
Credentials:PA (ASCP)
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4129 VENICE DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-1932
Mailing Address - Country:US
Mailing Address - Phone:814-977-3126
Mailing Address - Fax:
Practice Address - Street 1:201 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16550-0002
Practice Address - Country:US
Practice Address - Phone:814-877-6027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant