Provider Demographics
NPI:1982433082
Name:WIEMKEN, ANNA ROSE (NP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:ROSE
Last Name:WIEMKEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:ROSE
Other - Last Name:HOCHHALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1665 43RD ST S STE 101
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3316
Mailing Address - Country:US
Mailing Address - Phone:701-866-0561
Mailing Address - Fax:
Practice Address - Street 1:1665 43RD ST S STE 101
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3316
Practice Address - Country:US
Practice Address - Phone:701-866-0561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND200289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily