Provider Demographics
NPI:1558981308
Name:WIENS, DARREN (CP, BOCO, MS)
Entity Type:Individual
Prefix:
First Name:DARREN
Middle Name:
Last Name:WIENS
Suffix:
Gender:M
Credentials:CP, BOCO, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-7449
Mailing Address - Country:US
Mailing Address - Phone:308-293-6643
Mailing Address - Fax:
Practice Address - Street 1:306 E 6TH ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-7449
Practice Address - Country:US
Practice Address - Phone:308-293-6643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NECP-3619224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty