Provider Demographics
NPI:1548971617
Name:WIENER, MARIE LOUISE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:LOUISE
Last Name:WIENER
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 1:710 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:SAUK CENTRE
Mailing Address - State:MN
Mailing Address - Zip Code:56378-1645
Mailing Address - Country:US
Mailing Address - Phone:320-352-1201
Mailing Address - Fax:320-352-3970
Practice Address - Street 1:710 MAIN ST S
Practice Address - Street 2:
Practice Address - City:SAUK CENTRE
Practice Address - State:MN
Practice Address - Zip Code:56378-1645
Practice Address - Country:US
Practice Address - Phone:320-352-1201
Practice Address - Fax:320-352-3970
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist