Provider Demographics
NPI:1639656580
Name:WIER, CALLA RAE
Entity Type:Individual
Prefix:
First Name:CALLA
Middle Name:RAE
Last Name:WIER
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 1:2167 RIDGECREST RD SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-4382
Mailing Address - Country:US
Mailing Address - Phone:616-272-4268
Mailing Address - Fax:616-719-0127
Practice Address - Street 1:2167 RIDGECREST RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-4382
Practice Address - Country:US
Practice Address - Phone:616-272-4268
Practice Address - Fax:616-719-0127
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant