Provider Demographics
NPI:1174920730
Name:WIESENDANGER, BETH ANNE (MS)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ANNE
Last Name:WIESENDANGER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 HEWLETT AVE
Mailing Address - Street 2:BOX 500
Mailing Address - City:POINT LOOKOUT
Mailing Address - State:NY
Mailing Address - Zip Code:11569-3011
Mailing Address - Country:US
Mailing Address - Phone:516-889-2335
Mailing Address - Fax:
Practice Address - Street 1:139 HEWLETT AVE
Practice Address - Street 2:BOX 500
Practice Address - City:POINT LOOKOUT
Practice Address - State:NY
Practice Address - Zip Code:11569-3011
Practice Address - Country:US
Practice Address - Phone:516-889-2335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY517339174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist