Provider Demographics
NPI:1841393055
Name:WIER, STACIE L (NP)
Entity Type:Individual
Prefix:MS
First Name:STACIE
Middle Name:L
Last Name:WIER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 CHAIRFACTORY RD
Mailing Address - Street 2:
Mailing Address - City:ELMA
Mailing Address - State:NY
Mailing Address - Zip Code:14059
Mailing Address - Country:US
Mailing Address - Phone:716-652-2022
Mailing Address - Fax:
Practice Address - Street 1:41 MAPLE RD
Practice Address - Street 2:MAPLE MEDICAL SERVICES, P.C.
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2918
Practice Address - Country:US
Practice Address - Phone:716-631-1045
Practice Address - Fax:716-631-1365
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF4207091363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
000560899001OtherBCBS
NYRA5165Medicare ID - Type Unspecified
Q31837Medicare UPIN