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NPI Code Detail

MEDICARE: WENDY A WIGMORE

MEDICARE: WENDY A 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
1332B00000XDurable Medical Equipment & Medical SuppliesPENDINGCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
147185OTHERCASTATE OF CALIFORNIA DEPT OF PUBLIC HEALTH
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1427102235
Entity Type Code : Organization
Provider Name (Legal Business Name) : WENDY A WIGMORE
Provider Business Mailing Address
First Line : 604 MAIN ST
Second Line :
City : WOODLAND
State : CA
Zip : 95695-3405
Country : US
Telephone Number : 530-661-7409
Fax Number : 530-644-4163
Provider Business Practice Location Address
First Line : 604 MAIN ST
Second Line :
City : WOODLAND
State : CA
Zip : 95695-3405
Country : US
Telephone Number : 530-661-7409
Fax Number : 530-644-4163
Authorized Official
Title or Position : OWNER
Name : WENDY ANN WIGMORE
Credential : RN
Telephone Number : 707-446-7014
Provider Enumeration Date : 01/22/2007
Last Update Date : 04/20/2009

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