Provider Demographics
NPI:1639708530
Name:WIEST, DEVLIN ANN (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:DEVLIN
Middle Name:ANN
Last Name:WIEST
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 UNIVERSITY AVE APT 320
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-3567
Mailing Address - Country:US
Mailing Address - Phone:612-715-2706
Mailing Address - Fax:
Practice Address - Street 1:851 UNIVERSITY AVE APT 320
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-3567
Practice Address - Country:US
Practice Address - Phone:612-715-2706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer