| NPI | 1982924502 |
|---|---|
| Former Name | KRISTY MICHELLE WIEBKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery (Licence: GA 78850) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL UO2440) |
| 208600000X Surgery (Licence: LA DO000449) | |
| Enumeration Date | 2010-06-05 |
| Last Update Date | 2021-03-15 |