Provider Demographics
NPI:1841938875
Name:WIEAND, ZOE MIKAYLA
Entity type:Individual
Prefix:
First Name:ZOE
Middle Name:MIKAYLA
Last Name:WIEAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ZOE
Other - Middle Name:MIKAYLA
Other - Last Name:SHELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4281 GREEN PARK DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT JOY
Mailing Address - State:PA
Mailing Address - Zip Code:17552-8877
Mailing Address - Country:US
Mailing Address - Phone:717-725-9221
Mailing Address - Fax:
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2207
Practice Address - Country:US
Practice Address - Phone:717-544-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant