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NPI Code Detail

MEDICARE: DR. MARY MICHELLE WEGNER MD

MEDICARE: DR. MARY MICHELLE WEGNER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianE4222AR

General Provider Information

NPI Number : 1013983071
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY MICHELLE WEGNER MD
Provider Business Mailing Address
First Line : 2707 BROWNS LN
Second Line :
City : JONESBORO
State : AR
Zip : 72401-7213
Country : US
Telephone Number : 870-972-4961
Fax Number : 870-972-4088
Provider Business Practice Location Address
First Line : 2707 BROWNS LN
Second Line :
City : JONESBORO
State : AR
Zip : 72401-7213
Country : US
Telephone Number : 870-972-4961
Fax Number : 870-972-4088
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2006
Last Update Date : 07/08/2007

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Directions to “ DR. MARY MICHELLE WEGNER MD” Practice Location

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