Provider Demographics
NPI:1831716828
Name:WIECKOWSKI, MICHELE LEIGH (APRN)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:LEIGH
Last Name:WIECKOWSKI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 DEEPWOODS TRL
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-8634
Mailing Address - Country:US
Mailing Address - Phone:512-762-6345
Mailing Address - Fax:
Practice Address - Street 1:440 FISCHER STORE RD
Practice Address - Street 2:
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-6158
Practice Address - Country:US
Practice Address - Phone:844-767-9965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX803210163WP0808X
TXAP1032763363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health