Provider Demographics
NPI:1740648807
Name:WIEGAND, DOROTHY (NP)
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:
Last Name:WIEGAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 LAUREL OAK RD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4453
Mailing Address - Country:US
Mailing Address - Phone:856-344-7360
Mailing Address - Fax:856-783-1403
Practice Address - Street 1:151 FRIES MILL RD
Practice Address - Street 2:SUITE 301
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-2016
Practice Address - Country:US
Practice Address - Phone:856-374-1881
Practice Address - Fax:856-302-1961
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00586300363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care