Provider Demographics
NPI:1962637918
Name:WIESE, NANCY KAY (DO)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:KAY
Last Name:WIESE
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:45 CASTRO ST CPMC DAVIES CAMPUS
Mailing Address - Street 2:SOUTH TOWER LEVEL A SUITE 160A
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1010
Mailing Address - Country:US
Mailing Address - Phone:415-600-6616
Mailing Address - Fax:
Practice Address - Street 1:45 CASTRO ST CPMC DAVIES CAMPUS
Practice Address - Street 2:SOUTH TOWER LEVEL A SUITE 160A
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1010
Practice Address - Country:US
Practice Address - Phone:415-600-6616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A46342083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine