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General NPI Number Information
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NPI Number | 1033285242
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Entity Type | Individual
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Provider Name | CAROL LYDIA WIEDIGER APRN
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Gender | Female
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 11/14/2023
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Provider Practice Location Address
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Address Line | 3111 ELECTRIC AVE
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City | PORT HURON
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State | MI
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Zip | 48060-8127
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Country | US
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Telephone | 810-985-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 500 VINE STREET HUMAN RESOURCES
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City | HARTFORD
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State | CT
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Zip | 06112
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Country | US
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Telephone | 860-297-0905
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Fax | 860-297-0914
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704367059
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 403445
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 000886
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 202201526NP-PP
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License Number State | OR
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