Organization
WENDY A WIGMORE
Active
Other names
Jackson Medical Supply
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY ANN WIGMORE RN (OWNER)
(707) 446-7014
Entity
Organization
Contact information
Practice address
604 MAIN ST, WOODLAND, CA 95695-3405
(530) 661-7409
(530) 644-4163
Mailing address
604 MAIN ST, WOODLAND, CA 95695-3405
(530) 661-7409
(530) 644-4163
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
PENDING
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
47185
STATE OF CALIFORNIA DEPT OF PUBLIC HEALTH
CA
05
—
DME03183F
—
CA
Enumeration date
01/22/2007
Last updated
04/20/2009
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