| NPI | 1184909657 |
|---|---|
| Former Name | KATIE SUE WIGGENJOST |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 002235) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085004132) |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2014-09-30 |