Provider Demographics
NPI:1588854988
Name:WIGEN, MONA (CMT)
Entity Type:Individual
Prefix:MS
First Name:MONA
Middle Name:
Last Name:WIGEN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3745 E MINERAL POND BLVD
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-1046
Mailing Address - Country:US
Mailing Address - Phone:763-427-7536
Mailing Address - Fax:
Practice Address - Street 1:3745 E MINERAL POND BLVD
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-1046
Practice Address - Country:US
Practice Address - Phone:763-427-7536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist