Provider Demographics
NPI:1043210990
Name:WIGEN, SANDRA (CNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:WIGEN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 YARD ST
Mailing Address - Street 2:STE 200
Mailing Address - City:GRANDVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-3930
Mailing Address - Country:US
Mailing Address - Phone:614-434-2400
Mailing Address - Fax:614-434-2499
Practice Address - Street 1:6075 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1549
Practice Address - Country:US
Practice Address - Phone:614-434-2400
Practice Address - Fax:614-434-2499
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP01913363LX0001X
OHRN200521363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2077603Medicaid
OHWINP10661Medicare ID - Type Unspecified6075 E BROAD STREET
OH2077603Medicaid