Provider Demographics
NPI:1548223175
Name:WIESE, RUTH ANN (RNC FNP)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:ANN
Last Name:WIESE
Suffix:
Gender:F
Credentials:RNC FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225
Mailing Address - Country:US
Mailing Address - Phone:804-560-4025
Mailing Address - Fax:
Practice Address - Street 1:1300 EAST MARSHAL ST
Practice Address - Street 2:NORTH HOSPITAL G004
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298
Practice Address - Country:US
Practice Address - Phone:804-828-4624
Practice Address - Fax:804-828-3983
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024123321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7785135Medicaid
500000601Medicare ID - Type Unspecified