Provider Demographics
NPI:1891021366
Name:WIELAND, GERI ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:GERI
Middle Name:ANN
Last Name:WIELAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GERI
Other - Middle Name:ANN
Other - Last Name:EDMONDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-6770
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:2125 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-5836
Practice Address - Country:US
Practice Address - Phone:989-254-6427
Practice Address - Fax:989-607-1314
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002045363AS0400X
MI5601005609363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical