Provider Demographics
NPI:1710431630
Name:WIEGAND, TERESA
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:WIEGAND
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 1:14241 ROCKFORD SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:HURT
Mailing Address - State:VA
Mailing Address - Zip Code:24563-3801
Mailing Address - Country:US
Mailing Address - Phone:434-851-2695
Mailing Address - Fax:434-324-7675
Practice Address - Street 1:14241 ROCKFORD SCHOOL RD
Practice Address - Street 2:
Practice Address - City:HURT
Practice Address - State:VA
Practice Address - Zip Code:24563-3801
Practice Address - Country:US
Practice Address - Phone:434-851-2695
Practice Address - Fax:434-324-7675
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver