Provider Demographics
NPI:1679386676
Name:WIETFELD, MARY ANN
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:WIETFELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 N NYE AVE APT 207
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2276
Mailing Address - Country:US
Mailing Address - Phone:402-720-1468
Mailing Address - Fax:
Practice Address - Street 1:2428 N NYE AVE APT 207
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2276
Practice Address - Country:US
Practice Address - Phone:402-720-1468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion