| Doctor Name: | JOANNA WIEGAND |
| NPI Number: | 1114309911 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | MA057667 |
| Business Practice Address: | 5300 Kidspeace Dr Orefield, PA - 180692044 |
| Business Phone Number: | 6107997492 |
| Business Fax Number: | |
| Mailing Address: | 110 Girard Ave, HATBORO |
| State: | PA |
| Postal Code: | 190401622 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 06/29/2015 |
| NPI Last Update Date: | 12/15/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | MA057667 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |