Healthcare Provider Details

I. General information

NPI: 1245230424
Provider Name (Legal Business Name): WENDY WIGMORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 MAIN ST
VACAVILLE CA
95688-3912
US

IV. Provider business mailing address

506 MAIN ST
VACAVILLE CA
95688-3912
US

V. Phone/Fax

Practice location:
  • Phone: 707-446-7014
  • Fax: 707-446-1871
Mailing address:
  • Phone: 707-446-7014
  • Fax: 707-446-1871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number103834
License Number StateCA

VIII. Authorized Official

Name: WENDY A WIGMORE
Title or Position: OWNER
Credential: RN
Phone: 707-446-7014