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General NPI Number Information
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NPI Number | 1942736087
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Entity Type | Individual
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Provider Name | JEANNE WIGANT MD
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Gender | Female
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 10/02/2021
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Provider Practice Location Address
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Address Line | 380 W 100 N
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City | MONTICELLO
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State | UT
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Zip | 84535-7879
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Country | US
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Telephone | 435-587-1148
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 308
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City | MONTICELLO
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State | UT
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Zip | 84535-0308
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Country | US
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Telephone | 435-487-5054
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Fax | 435-587-3495
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD61052795
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD61052795
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 10901609-1205
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License Number State | UT
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