Provider Demographics
NPI:1689144529
Name:WIESSNER, SUSAN (PATHOLOGISTS' ASSIST)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:WIESSNER
Suffix:
Gender:F
Credentials:PATHOLOGISTS' ASSIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 13TH ST
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-3958
Mailing Address - Country:US
Mailing Address - Phone:763-227-8860
Mailing Address - Fax:
Practice Address - Street 1:475 KIRMAN AVE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1907
Practice Address - Country:US
Practice Address - Phone:775-334-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV27184-AP-3207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology