Provider Demographics
NPI:1942736087
Name:WIGANT, JEANNE (MD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:WIGANT
Suffix:
Gender:F
Credentials:MD
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 308
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:UT
Mailing Address - Zip Code:84535-0308
Mailing Address - Country:US
Mailing Address - Phone:435-487-5054
Mailing Address - Fax:435-587-3495
Practice Address - Street 1:380 W 100 N
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:UT
Practice Address - Zip Code:84535-7879
Practice Address - Country:US
Practice Address - Phone:435-587-1148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61052795207Q00000X, 207V00000X
UT10901609-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology