Provider Demographics
NPI:1568550135
Name:WEDIG, KIMBERLY A (RN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:WEDIG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19999 FERNDALE RD
Mailing Address - Street 2:
Mailing Address - City:MINERAL POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53565-8655
Mailing Address - Country:US
Mailing Address - Phone:608-987-9986
Mailing Address - Fax:
Practice Address - Street 1:19999 FERNDALE RD
Practice Address - Street 2:
Practice Address - City:MINERAL POINT
Practice Address - State:WI
Practice Address - Zip Code:53565-8655
Practice Address - Country:US
Practice Address - Phone:608-987-9986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35001500Medicaid