Individual
JESSICA A. WIEDEMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7601 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4133
(260) 436-8686
(260) 436-8585
Mailing address
3926 NEW VISION DR, FORT WAYNE, IN 46845-1712
(260) 436-8686
(260) 436-8585
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71006951A
IN
Other
Enumeration date
03/13/2017
Last updated
09/18/2017
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