IndividualActive
Larry Wiedenhoft, EMT
NPI 1972139418 · Emergency Medical Services (Emergency Medicine) Physician · Manzanita, OR
Provider details
- NPI number
- 1972139418
- Entity type
- Individual
- Primary specialty
- Emergency Medical Services (Emergency Medicine) PhysicianAllopathic & Osteopathic Physicians
- Credential
- EMT
- Sex
- Male
- Sole proprietor
- No
- License
- 143317 (OR)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
465 Manzanita Ave
Manzanita, OR 97130-0810
Phone: (503) 704-1006
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 810
Manzanita, OR 97130-0810
Registry dates
- Enumerated
- 2020-03-17
- Last updated
- 2020-03-17
- Certified
- 2020-03-17
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.