Provider Demographics
NPI:1427183227
Name:WIGAL, VONDA M (ARNP)
Entity Type:Individual
Prefix:
First Name:VONDA
Middle Name:M
Last Name:WIGAL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:VONDA
Other - Middle Name:M
Other - Last Name:DONOVAN (MAIDEN)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:7348 W 21ST ST N STE 121
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1765
Mailing Address - Country:US
Mailing Address - Phone:316-722-0103
Mailing Address - Fax:316-722-2223
Practice Address - Street 1:7348 W 21ST ST N STE 121
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1765
Practice Address - Country:US
Practice Address - Phone:316-722-0103
Practice Address - Fax:316-722-2223
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45218363LP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30000004RUWQEAUOtherEHR CERTIFICATION
KS200543290CMedicaid
KS200543290CMedicaid