Provider Demographics
NPI:1710380258
Name:WIELAND, STEPHANIE H (APN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:H
Last Name:WIELAND
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:H
Other - Last Name:SCHIELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 MAIN ST STE 400
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61606-2036
Mailing Address - Country:US
Mailing Address - Phone:309-308-9010
Mailing Address - Fax:309-308-0919
Practice Address - Street 1:1001 MAIN ST STE 400
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61606-2036
Practice Address - Country:US
Practice Address - Phone:309-308-0910
Practice Address - Fax:309-308-0919
Is Sole Proprietor?:No
Enumeration Date:2014-09-29
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-011938363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner