Healthcare Provider Details

I. General information

NPI: 1184471294
Provider Name (Legal Business Name): ELIZA WIGGIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 N HIGH ST
DENVER CO
80205-5555
US

IV. Provider business mailing address

4060 UPHAM ST
WHEAT RIDGE CO
80033
US

V. Phone/Fax

Practice location:
  • Phone: 203-856-9416
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number1638305
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRXN.0109079-NP
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN.1000074-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: