Provider Demographics
NPI:1740419696
Name:WIGERT, JOSEPHINE ANNETTE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:ANNETTE
Last Name:WIGERT
Suffix:
Gender:F
Credentials:RN
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 99
Mailing Address - Street 2:
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:MN
Mailing Address - Zip Code:56567-0099
Mailing Address - Country:US
Mailing Address - Phone:218-385-5500
Mailing Address - Fax:
Practice Address - Street 1:118 NORTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:NEW YORK MILLS
Practice Address - State:MN
Practice Address - Zip Code:56567
Practice Address - Country:US
Practice Address - Phone:218-385-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR108120-6172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker