Healthcare Provider Details

I. General information

NPI: 1972081065
Provider Name (Legal Business Name): ALINA M WIGGINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 JAHNKE RD STE 500
RICHMOND VA
23225-4017
US

IV. Provider business mailing address

7101 JAHNKE RD STE 500
RICHMOND VA
23225-4017
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-2751
  • Fax: 804-330-3831
Mailing address:
  • Phone: 804-320-2751
  • Fax: 804-330-3831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024176429
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: