Individual
JILL WEGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
6777 W MAPLE RD, WEST BLOOMFIELD, MI 48322-3013
(248) 325-1000
Mailing address
6777 W MAPLE RD, WEST BLOOMFIELD, MI 48322-3013
(248) 325-1000
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
4704195321
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10-4680917
—
MI
05
—
10-4689008
—
MI
05
—
10-4689026
—
MI
05
—
10-4689035
—
MI
05
—
10-4689044
—
MI
05
—
11-4940999
—
MI
05
—
11-4941000
—
MI
05
—
11-4941010
—
MI
05
—
11-4941029
—
MI
Enumeration date
11/11/2006
Last updated
04/09/2024
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