Healthcare Provider Details

I. General information

NPI: 1841134152
Provider Name (Legal Business Name): BROOKE WIGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 S 4TH ST
LEBANON PA
17042-6111
US

IV. Provider business mailing address

601 MEMORY LN
YORK PA
17402-2231
US

V. Phone/Fax

Practice location:
  • Phone: 717-475-0577
  • Fax:
Mailing address:
  • Phone: 717-851-2613
  • Fax: 717-798-3677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP036655
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: