Provider Demographics
NPI:1851641377
Name:WIEST, EVANGELINE SARA (RN)
Entity Type:Individual
Prefix:MISS
First Name:EVANGELINE
Middle Name:SARA
Last Name:WIEST
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 S HERBERT AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85701-2735
Mailing Address - Country:US
Mailing Address - Phone:520-262-8682
Mailing Address - Fax:
Practice Address - Street 1:733 S HERBERT AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85701-2735
Practice Address - Country:US
Practice Address - Phone:520-262-8682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN165910282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital