Provider Demographics
NPI:1457697872
Name:WIEST, MARIA G (IDMT)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:G
Last Name:WIEST
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12222 S 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-1865
Mailing Address - Country:US
Mailing Address - Phone:402-637-5707
Mailing Address - Fax:
Practice Address - Street 1:12222 S 25TH AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-1865
Practice Address - Country:US
Practice Address - Phone:402-637-5707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians