Individual provider Active NPI

Jeanette Ann Wiesner, CNP

  • Nurse Practitioner
  • Cincinnati, OH
National Provider Identifier
1114107778
Registry record updated Nov 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
NP-06876 Issued in OH
Practice address
4260 Glendale Milford Rd
Suite 201
Cincinnati, OH 45242-3763
Phone
(513) 769-2762
Fax
(512) 769-2769
NPI assigned
Nov 11, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NP-06876 OH Primary

Addresses

Primary practice location

4260 Glendale Milford Rd
Suite 201
Cincinnati, OH 45242-3763

Mailing address

4260 Glendale Milford Rd
Suite 201
Cincinnati, OH 45242-3763
Phone (513) 769-2762

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Certified Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP-06876OHMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Allergy & Asthma Affiliates, Inc PastSince Jan 1, 1997 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194739200000",
    "number": "1114107778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4260 GLENDALE MILFORD RD",
            "address_2": "SUITE 201",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452423763",
            "telephone_number": "513-769-2762",
            "fax_number": "512-769-2769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4260 GLENDALE MILFORD RD",
            "address_2": "SUITE 201",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452423763",
            "telephone_number": "513-769-2762",
            "fax_number": "512-769-2769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIESNER",
        "first_name": "JEANETTE",
        "middle_name": "ANN",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-11",
        "last_updated": "2007-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "NP-06876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.