Individual
JENNIFER WEGENHOFT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
610 S AUSTIN RD, EAGLE LAKE, TX 77434-3202
(979) 234-2551
(979) 234-5994
Mailing address
610 S AUSTIN RD, EAGLE LAKE, TX 77434-3202
(979) 234-2551
(979) 234-5994
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10912
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1137272
NCCPA
—
Enumeration date
09/15/2016
Last updated
11/18/2016
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