Provider Demographics
NPI:1598758286
Name:WICHNER, MONICA HEIDI (DO)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:HEIDI
Last Name:WICHNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4102
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-4102
Mailing Address - Country:US
Mailing Address - Phone:775-443-2260
Mailing Address - Fax:
Practice Address - Street 1:1495 MILL ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:775-982-3663
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV937208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002013066Medicaid
11042222OtherCAQH
NV002013066Medicaid
NVDI011ZMedicare PIN
G53871Medicare UPIN