Healthcare Provider Details

I. General information

NPI: 1912984675
Provider Name (Legal Business Name): HELEN LIANA WIGGINS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 N MACARTHUR BLVD
IRVING TX
75038-6412
US

IV. Provider business mailing address

13601 PRESTON RD SUITE 900W
DALLAS TX
75240-4911
US

V. Phone/Fax

Practice location:
  • Phone: 972-789-2816
  • Fax: 866-554-1429
Mailing address:
  • Phone: 972-233-1999
  • Fax: 972-386-4292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number255827
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: