Wiese, Jonathan Richard
Wiese, Jonathan Richard is an individual health care provider with primary practice located at 4921 Parkview Pl Div Neurology Stroke, Ste 6C, Saint Louis MO 63110-1032. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Primary Care, which is considered as his primary health care specialty. Wiese, Jonathan Richard can be contacted via phone (314) 362-7382.Contact Information
Primary practice address
4921 Parkview Pl Div Neurology Stroke, Ste 6C
Saint Louis MO 63110-1032
Phone: (314) 362-7382
Fax: (314) 747-3342
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Primary Care | 363LP2300X | 2024008621 | Missouri |
Profile Details
| NPI number | 1487130746 |
|---|---|
| LBN Legal business name | Wiese, Jonathan Richard |
| Credentials | AGNP |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 19th, 2018 |
| Last updated | Apr 17th, 2025 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1487130746 | NPPES |
| Missouri | MEDICAID | 420141831 |
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