Provider Demographics
NPI:1891899209
Name:WIEGERS, JULIA (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:
Last Name:WIEGERS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 HARTMAN LN
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62221-8014
Mailing Address - Country:US
Mailing Address - Phone:618-641-9011
Mailing Address - Fax:
Practice Address - Street 1:1116 HARTMAN LN
Practice Address - Street 2:
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62221-8014
Practice Address - Country:US
Practice Address - Phone:618-641-9011
Practice Address - Fax:618-641-9017
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003021315363LF0000X
IL209.006539363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL536470001Medicare PIN