Healthcare Provider Details

I. General information

NPI: 1285482190
Provider Name (Legal Business Name): NICHOLAS WIEGAND PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2024
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 COMPETITION DRIVE SUITE 100
BETTENDORF IA
52722-8837
US

IV. Provider business mailing address

5250 COMPETITION DRIVE SUITE 100
BETTENDORF IA
52722-8837
US

V. Phone/Fax

Practice location:
  • Phone: 563-322-0971
  • Fax:
Mailing address:
  • Phone: 563-322-0971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: