Doctor Name: | DIANE L WIEGAND |
NPI Number: | 1215261078 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | AP101037 |
Business Practice Address: | 149 North St Waterville, ME - 049014974 |
Business Phone Number: | 2078616867 |
Business Fax Number: | |
Mailing Address: | 149 North St, WATERVILLE |
State: | ME |
Postal Code: | 049014974 |
Phone Number: | 2078616867 |
Fax Number: | |
NPI Enumeration Date: | 09/28/2009 |
NPI Last Update Date: | 08/19/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0808X |
License Number: | AP101037 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Psych/Mental Health |
Taxonomy Definition: |