Individual
MS. JEAN L WIEGAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2001 VAIL AVE, CHARLOTTE, NC 28207-1248
(704) 304-5000
Mailing address
4400 GOLF ACRES DR STE A, CHARLOTTE, NC 28208-5906
(704) 512-6428
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
69488
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8052003
—
NC
05
—
NAN668
—
SC
Enumeration date
06/12/2006
Last updated
07/21/2022
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