Provider Demographics
NPI:1013427004
Name:AILEEN LESLIE WEDVIK ARNP PLLC
Entity Type:Organization
Organization Name:AILEEN LESLIE WEDVIK ARNP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEDVIK
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:253-581-3075
Mailing Address - Street 1:4909 108TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3724
Mailing Address - Country:US
Mailing Address - Phone:253-581-3075
Mailing Address - Fax:253-581-3178
Practice Address - Street 1:4909 108TH ST SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3724
Practice Address - Country:US
Practice Address - Phone:253-581-3075
Practice Address - Fax:253-581-3178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-04
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain