Provider Demographics
NPI:1194599654
Name:WIGNER, SARAH JANE
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:JANE
Last Name:WIGNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-2345
Mailing Address - Country:US
Mailing Address - Phone:406-260-3105
Mailing Address - Fax:
Practice Address - Street 1:4 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2345
Practice Address - Country:US
Practice Address - Phone:406-260-3105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTA1127704-7100609374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide