Provider Demographics
NPI:1609900174
Name:WIGAL, PAULA SUE
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:SUE
Last Name:WIGAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6351 BRENT CT
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-3544
Mailing Address - Country:US
Mailing Address - Phone:614-575-1923
Mailing Address - Fax:614-575-1923
Practice Address - Street 1:6351 BRENT CT
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-3544
Practice Address - Country:US
Practice Address - Phone:614-575-1923
Practice Address - Fax:614-575-1923
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2168470Medicaid