Individual
MRS. DEADRA JEANNA WIEGEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
337 S HARRISON ST, LEBANON, KY 40033-1150
(270) 465-7896
Mailing address
337 S HARRISON ST, LEBANON, KY 40033-1150
(270) 465-7896
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
A001748
KY
Other
Enumeration date
07/30/2008
Last updated
07/30/2008
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