MEDICARE: WENDY WIGMORE

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
1	332B00000X	Durable Medical Equipment & Medical Supplies	103834	CA

General Provider Information

NPI Number	:	1245230424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WENDY WIGMORE

Provider Business Mailing Address
First Line	:	506 MAIN ST
Second Line	:
City	:	VACAVILLE
State	:	CA
Zip	:	95688-3912
Country	:	US
Telephone Number	:	707-446-7014
Fax Number	:	707-446-1871

Provider Business Practice Location Address
First Line	:	506 MAIN ST
Second Line	:
City	:	VACAVILLE
State	:	CA
Zip	:	95688-3912
Country	:	US
Telephone Number	:	707-446-7014
Fax Number	:	707-446-1871

Authorized Official
Title or Position	:	OWNER
Name	:	WENDY A WIGMORE
Credential	:	RN
Telephone Number	:	707-446-7014

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	06/24/2008

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