Provider Demographics
NPI:1538197603
Name:WIGENT, PAMELA J (NP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:WIGENT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 668
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-0638
Mailing Address - Fax:585-273-3359
Practice Address - Street 1:500 RED CREEK DR
Practice Address - Street 2:SUITE 120
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623
Practice Address - Country:US
Practice Address - Phone:585-487-3420
Practice Address - Fax:585-334-3327
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY420204363LW0102X
NYF420204363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02508152Medicaid
NYNP0147OtherPREFERRED CARE
NYP019420204OtherBLUE CHOICE
NYJ400002942Medicare PIN
NY02508152Medicaid
NYJ400041855Medicare PIN