Provider Demographics
NPI:1134464324
Name:WIEGAND, GREG E (PA-C)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:E
Last Name:WIEGAND
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:415 JEFFERSON ST NORTH
Mailing Address - Street 2:TRI-COUNTY HOSPITAL
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-1296
Mailing Address - Country:US
Mailing Address - Phone:218-631-3510
Mailing Address - Fax:218-631-7507
Practice Address - Street 1:415 JEFFERSON ST NORTH
Practice Address - Street 2:TRI-COUNTY HOSPITAL
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-1296
Practice Address - Country:US
Practice Address - Phone:218-631-3510
Practice Address - Fax:218-631-7507
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2016-10-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN1846363A00000X
MN11286363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant