Provider Demographics
NPI:1558978122
Name:WIECEK, KAREN ANN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:WIECEK
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 1:2113 S STATE ROUTE 231
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-4401
Mailing Address - Country:US
Mailing Address - Phone:419-680-8583
Mailing Address - Fax:
Practice Address - Street 1:95 AUTUMN LN
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-3375
Practice Address - Country:US
Practice Address - Phone:419-618-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7201195Medicaid