Provider Demographics
NPI:1831904911
Name:WIELAND, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:WIELAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:WIELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WIDENER,SHAW,OELTJEN
Mailing Address - Street 1:9560 N DENMAN AVE
Mailing Address - Street 2:
Mailing Address - City:KENESAW
Mailing Address - State:NE
Mailing Address - Zip Code:68956-1631
Mailing Address - Country:US
Mailing Address - Phone:402-462-0879
Mailing Address - Fax:
Practice Address - Street 1:9560 N DENMAN AVE
Practice Address - Street 2:
Practice Address - City:KENESAW
Practice Address - State:NE
Practice Address - Zip Code:68956-1631
Practice Address - Country:US
Practice Address - Phone:402-462-0879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion