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General NPI Number Information
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NPI Number | 1861937419
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Entity Type | Organization
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Legal Business Name | JENNIFER IRENE WAKELAND BIGELOW MD
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Dates
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Enumeration Date | 01/05/2017
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Last Update Date | 02/23/2017
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Provider Practice Location Address
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Address Line | 461 TOWN CENTER ST N
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City | MOORESVILLE
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State | IN
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Zip | 46158-2316
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Country | US
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Telephone | 317-584-3255
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Fax | 317-584-3259
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Provider Business Mailing Address
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Address Line | 461 TOWN CENTER ST N
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City | MOORESVILLE
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State | IN
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Zip | 46158-2316
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Country | US
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Telephone | 317-584-3255
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Fax | 317-584-3259
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. JENNIFER IRENE WAKELAND BIGELOW
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Credential | MD
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Telephone | 317-584-3255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | 01050867A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01050867A
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License Number State | IN
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