Individual
SHANNON WIEGEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Credential
BSN RN
Contact information
Practice address
1065 W BROADWAY AVE, MEDFORD, WI 54451-1311
(715) 748-2316
Mailing address
124 W STATE ST, MEDFORD, WI 54451-1760
(715) 748-6839
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
166319-30
WI
Other
Enumeration date
05/20/2026
Last updated
05/20/2026
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