Individual
NICHOLAS MARTIN WIEGAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC, LAT
Contact information
Practice address
600 CAMPUS DR, WENTZVILLE, MO 63385-3433
(636) 327-3876
Mailing address
11111 WHISPERING OAKS DR, SAINT LOUIS, MO 63136-5826
(314) 479-0628
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2017026211
MO
Other
Enumeration date
06/25/2019
Last updated
05/16/2023
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