=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194919688
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WENDY ELIZABETH ZIEGLER DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2007
-----------------------------------------------------
Last Update Date | 01/04/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6600 BRUCEVILLE RD
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95823-4671
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-688-6215
-----------------------------------------------------
Fax | 916-627-7148
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6600 BRUCEVILLE RD
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95823-4671
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-688-6215
-----------------------------------------------------
Fax | 916-627-7148
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 20A10275
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------