Individual
MALISSA R WIGHTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, APNP
Contact information
Practice address
2825 PRAIRIE AVE, BELOIT, WI 53511-1844
(608) 363-5500
Mailing address
2825 PRAIRIE AVE, BELOIT, WI 53511-1844
(608) 363-5500
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
1069
WI
363LP0200X
Pediatric Nurse Practitioner
113626
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43880300
—
WI
Enumeration date
04/25/2007
Last updated
07/08/2007
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