Provider Demographics
NPI:1699935510
Name:WIENS, ANDREA L (DO)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:L
Last Name:WIENS
Suffix:
Gender:F
Credentials:DO
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Other - Last Name:
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Mailing Address - Street 1:350 W 11TH ST
Mailing Address - Street 2:INDIANA UNIVERSITY HEATLH, DEPARTMENT OF PATHOLOGY
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-4108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 W 11TH ST
Practice Address - Street 2:INDIANA UNIVERSITY HEATLH, DEPARTMENT OF PATHOLOGY
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-4108
Practice Address - Country:US
Practice Address - Phone:765-717-5550
Practice Address - Fax:317-491-6419
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2011-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN02003724A207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology