NPI 1720230873

Kimberly Sue Wiegand, CFM

Practitioner Orthotic Fitter Maryville, IL

Practice location

Address: 2700 N Center St Rte 159, Maryville, IL 62062-5624
Phone: (618) 288-7474
Fax: (618) 288-7037

Registered specialties (3)

Orthotic Fitter Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 225000000X Licence CFM01697 (IL)

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Pharmacy Technician

Pharmacy Service Providers Taxonomy 183700000X Licence 049-177617 (IL)

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Medical Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363AM0700X Licence 95212 (IL)

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Registry record

NPI: 1720230873
Entity type: Individual
Sex (as registered): Female
NPI issued: 21 Oct 2008
Record last updated: 21 Oct 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.