Healthcare Provider Details

I. General information

NPI: 1730265372
Provider Name (Legal Business Name): LISA SPEAKS WIGGINS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HOSPITAL DR
MONROE NC
28112-6000
US

IV. Provider business mailing address

600 HOSPITAL DR
MONROE NC
28112-6000
US

V. Phone/Fax

Practice location:
  • Phone: 704-283-3179
  • Fax: 704-226-5800
Mailing address:
  • Phone: 704-283-3179
  • Fax: 704-226-5800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number048600
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: