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Jessica A. Wiedemann

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133

PECOS Enrollment

This provider is enrolled in PECOS as JESSICA WIEDEMANN.

Based on the most recent information from CMS, provider Jessica A. Wiedemann is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1093256950
Provider Type
Individual
Full Name
Wiedemann, Jessica A.
Credential
NP

Gender
Female
Sole Proprietor
No
Enumeration Date
3/13/2017
Last Updated
9/18/2017

Contact Information

Practice Location

7601 W Jefferson Blvd, Fort Wayne, IN 46804-4133

(260) 436-8686

(260) 436-8585

Mailing Location

3926 New Vision Dr, Fort Wayne, IN 46845-1712

(260) 436-8686

(260) 436-8585

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 71006951A Indiana

Jessica A. Wiedemann

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Howard, Amy M

Hufford, Theresa

Hermes, Tina J

Davis, Kelly

Lombard, Paige Marie

Fountain, Pamela Kinder

Parra, Michelle Ann

Renner, Melisa Kaye

Flack, Abigail

Pleshkan, Viktoriya Y.