Provider Demographics
NPI:1659546018
Name:WIGANT, JENNIFER NOEL (RD/LD)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:NOEL
Last Name:WIGANT
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 W SPRING CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-4325
Mailing Address - Country:US
Mailing Address - Phone:214-616-4213
Mailing Address - Fax:
Practice Address - Street 1:1508 W SPRING CREEK PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-4325
Practice Address - Country:US
Practice Address - Phone:214-616-4213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80236133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered