Carolyn Marie Wiese, PA

NPI #1235130576 in Petoskey, Michigan

Provider Information

NPI Number: 1235130576
Entity Type: Individual
Name: Carolyn Marie Wiese, PA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA
Enumeration Date: Aug 9, 2005
Last Updated: Jun 12, 2018

Practice Location

Address: 2390 MITCHELL PARK DR STE D
City: Petoskey
State: Michigan
ZIP Code: 49770
Phone: (231) 487-7200

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant - Medical — Medical	363AM0700X
Physician Assistant	363A00000X	Primary

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