Provider Demographics
NPI:1992887939
Name:WIEFERICH, BARBARA J (APRN, BC)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:WIEFERICH
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:40 WHITE OAK PROFESSIONAL CTR
Practice Address - Street 2:
Practice Address - City:VINCENT
Practice Address - State:OH
Practice Address - Zip Code:45784-9117
Practice Address - Country:US
Practice Address - Phone:740-678-2374
Practice Address - Fax:740-678-8139
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP01879363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
S79102Medicare UPIN
OHNP86841Medicare PIN
OHNP02933Medicare PIN
OHWINP02931Medicare PIN