Healthcare Provider Details

I. General information

NPI: 1902140981
Provider Name (Legal Business Name): ALICIA-ANN DANIELLE WIGGINS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

942 MONTFORD RD
CLEVELAND HTS OH
44121-2078
US

IV. Provider business mailing address

942 MONTFORD RD
CLEVELAND HEIGHTS OH
44121-2078
US

V. Phone/Fax

Practice location:
  • Phone: 216-414-8602
  • Fax:
Mailing address:
  • Phone: 216-414-8602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number144320
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: