Healthcare Provider Details

I. General information

NPI: 1811266257
Provider Name (Legal Business Name): ELIZABETH J WIGGINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 E 105TH ST
BROOKLYN NY
11236-2213
US

IV. Provider business mailing address

567 E 105TH ST
BROOKLYN NY
11236-2213
US

V. Phone/Fax

Practice location:
  • Phone: 718-307-3009
  • Fax: 718-307-3020
Mailing address:
  • Phone: 718-307-3009
  • Fax: 718-307-3020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number4953431
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: