Basic Information
Provider Information
NPI: 1366874042
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WIEGAND
FirstName: REBECCA
MiddleName: S
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 745319
Address2:  
City: ATLANTA
State: GA
PostalCode: 303745319
CountryCode: US
TelephoneNumber: 6153737600
FaxNumber:  
Practice Location
Address1: 1 HOSPITAL DR STE 4200
Address2:  
City: ASHEVILLE
State: NC
PostalCode: 288014550
CountryCode: US
TelephoneNumber: 8282131994
FaxNumber: 8282131992
Other Information
ProviderEnumerationDate: 08/05/2013
LastUpdateDate: 01/12/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/12/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XMA056235PAN Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363AS0400X0010-05336NCY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical

No ID Information.


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