Provider Demographics
NPI:1679283832
Name:WIETING, VICKI
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:WIETING
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 1:905 MAIN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-6066
Mailing Address - Country:US
Mailing Address - Phone:541-591-6440
Mailing Address - Fax:
Practice Address - Street 1:905 MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6066
Practice Address - Country:US
Practice Address - Phone:541-591-6440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246YR1600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationRegistered Record Administrator