Provider Demographics
NPI:1174633556
Name:WIEBERS, ROBERT J (APN)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:WIEBERS
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W CLARENDON AVE
Mailing Address - Street 2:SUITE 375
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3498
Mailing Address - Country:US
Mailing Address - Phone:602-277-4161
Mailing Address - Fax:602-266-3481
Practice Address - Street 1:300 W CLARENDON AVE
Practice Address - Street 2:SUITE 375
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3498
Practice Address - Country:US
Practice Address - Phone:602-277-4161
Practice Address - Fax:602-266-3481
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ61753363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal