Individual
REBECCA WIGANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
5405 N KNOXVILLE AVE, PEORIA, IL 61614-5016
(309) 691-4410
(309) 692-4730
Mailing address
5405 N KNOXVILLE AVE, PEORIA, IL 61614-5016
(309) 691-4410
(309) 692-4730
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
041346716
IL
Other
Enumeration date
09/12/2012
Last updated
09/12/2012
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