Provider Demographics
NPI:1992345177
Name:WIESELER, BRAEDON FRANCIS (PA-C)
Entity type:Individual
Prefix:MR
First Name:BRAEDON
Middle Name:FRANCIS
Last Name:WIESELER
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1414 26TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901
Mailing Address - Country:US
Mailing Address - Phone:507-358-9556
Mailing Address - Fax:
Practice Address - Street 1:1702 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:55901
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant