Individual
SHANNON WIEGAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1717 W COWLES ST, CAIHC, FAIRBANKS, AK 99701
(907) 451-6682
(907) 459-3811
Mailing address
1717 W COWLES ST, CAIHC, FAIRBANKS, AK 99701
(907) 451-6682
(907) 459-3811
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5143
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MD05432
—
AK
01
—
P0080955
RAILROAD MEDICARE PIN#
AK
Enumeration date
08/12/2006
Last updated
12/06/2012
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