Individual
JENNIFER VANDERWEGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
855 S MAIN ST, OCONTO FALLS, WI 54154-1241
(920) 846-3444
Mailing address
855 S MAIN ST, OCONTO FALLS, WI 54154-1241
(920) 846-3444
Taxonomy
Speciality
Code
Description
License number
State
227800000X
Certified Respiratory Therapist
Primary
3119-28
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3119-28
LICENSE NUMBER
WI
Enumeration date
04/08/2008
Last updated
04/08/2008
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