Provider Demographics
NPI:1619169968
Name:WIEGMANN-ROSS, MICHELE LEE (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:LEE
Last Name:WIEGMANN-ROSS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MRS
Other - First Name:MICHELE
Other - Middle Name:LEE
Other - Last Name:WIEGMANN-ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:1115 MOUNT ZION RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-2266
Mailing Address - Country:US
Mailing Address - Phone:770-960-9999
Mailing Address - Fax:770-960-0931
Practice Address - Street 1:1115 MOUNT ZION RD
Practice Address - Street 2:SUITE E
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2266
Practice Address - Country:US
Practice Address - Phone:770-960-9999
Practice Address - Fax:770-960-0931
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN145899NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics