THERON J WIESE (NPI# 1841648862) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1841648862 |
Entity Type | Individual |
Full Name | THERON J WIESE |
Credential | PA-C |
Practice Address |
1395 Commercial St Se Salem OR 97302-4205 |
Mailing Address |
6108 Sw 18th Dr Apt 9 Portland OR 97239-1951 |
Practice Telephone | 5039907187 |
Mailing Telephone | 9713449996 |
Enumeration Date | 2016-05-31 |
Last Update Date | 2017-10-24 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA184738 | OR | Physician Assistants & Advanced Practice Nursing Providers |
Street Address |
1395 COMMERCIAL ST SE |
City | SALEM |
State | OR |
Zip Code | 97302-4205 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1952954679 | Eric Anthony Bohm | Pharmacist | 2757 22nd St. Se, Salem, OR 97302 | 2019-07-22 |
1598223737 | Michael Robert Martini | Counselor | 960 Liberty Rd Se Suite 120, Salem, OR 97302 | 2019-03-06 |
1659857480 | Avalina Pharmacy Inc | Pharmacy | 3507 Commercial St Se, Salem, OR 97302 | 2018-07-16 |
1649762733 | Joseph Bochsler | Physical Therapist | 3220 Liberty Rd. S., Salem, OR 97302 | 2018-06-04 |
1922533652 | Brianne Elizabeth Sischo | Licensed Practical Nurse | 3871 Fairview Industrial Dr. Se Ste, 150, Salem, OR 97302 | 2017-05-01 |
1851825566 | Modern Nose Clinic LLC | Otolaryngology | 340 Vista Ave Se, Ste 100, Salem, OR 97302 | 2017-04-19 |
1720529803 | Nicholas Forsberg | Massage Therapist | 126 Mize Rd S, Salem, OR 97302 | 2017-03-09 |
1437691078 | Kimo Mahi | Specialist/Technologist, Other | 2373 Kuebler Rd. S, Salem, OR 97302 | 2016-11-14 |
1588113278 | New Life Family Medicine LLC | Clinic/Center | 842 Commercial Street Ne, Salem, OR 97302 | 2016-09-23 |
1073060117 | Susan Morag Robnett | Counselor | 912 Fir Street South, Salem, OR 97302 | 2016-09-07 |
Find all providers in zip 97302 |
Taxonomy Code | 363AM0700X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Medical |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1285255851 | Darby Samantha Jalbert | Physician Assistant | 2480 Liberty St Ne Ste 110, Salem, OR 97301-8381 | 2020-05-05 |
1639614852 | Gregory Bull | Physician Assistant | 622 Fernwood Dr, Salem, VA 24153-2654 | 2016-12-24 |
1922329697 | Charleen Ann Thorburn | Physician Assistant | 22 Keewaydin Dr, Salem, NH 03079-2839 | 2010-06-17 |
1316188006 | Judith A Mitchell | Physician Assistant | 4999 Skyline Rd. S., Salem, OR 97306 | 2009-03-10 |
1215912712 | Amy Gouley | Physician Assistant | 1793 13th St Se, Salem, OR 97302-2541 | 2005-12-07 |
1306827100 | William Earle Williams | Physician Assistant | 1233 Edgewater St Nw, Salem, OR 97304-4049 | 2005-11-08 |
1700485224 | Roderick Mao | Physician Assistant | 159 N Broadway, Salem, NH 03079-2136 | 2020-10-26 |
1447719752 | Christine Nicole Jeffries | Physician Assistant | 360 Church St Se, Salem, OR 97301-3796 | 2019-03-16 |
1265999338 | Brolin Johnson | Physician Assistant | 1793 13th St Se, Salem, OR 97302-2541 | 2019-02-26 |
1073088191 | Fiorella Saavedra | Physician Assistant | 255 Lancaster Dr Ne, Salem, OR 97301-5155 | 2018-10-04 |
Find all providers in SALEM |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.