Provider Demographics
NPI:1326665845
Name:WIENGES, JENNIFER ANN (CPM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:WIENGES
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:MADRONA
Other - Middle Name:
Other - Last Name:WIENGES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPM
Mailing Address - Street 1:PO BOX 1301
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-1301
Mailing Address - Country:US
Mailing Address - Phone:706-206-9909
Mailing Address - Fax:207-358-2558
Practice Address - Street 1:1052 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-3801
Practice Address - Country:US
Practice Address - Phone:706-206-9909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECPM682176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife