| Doctor Name: | NICOLAS WIEGAND |
| NPI Number: | 1275954190 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 46-4321873 |
| Business Practice Address: | 5933 S Highway 94 Suite 102 Weldon Spring, MO - 633045610 |
| Business Phone Number: | 3144795303 |
| Business Fax Number: | |
| Mailing Address: | 5933 S Highway 94, Suite 102 WELDON SPRING |
| State: | MO |
| Postal Code: | 633045610 |
| Phone Number: | 3144795303 |
| Fax Number: | |
| NPI Enumeration Date: | 12/18/2013 |
| NPI Last Update Date: | 12/18/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 46-4321873 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |