Healthcare Provider Details

I. General information

NPI: 1275126872
Provider Name (Legal Business Name): SEAN PIGGOTT RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 02/15/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2990 S LOGAN AVE
MILWAUKEE WI
53207
US

IV. Provider business mailing address

2990 S LOGAN AVE
MILWAUKEE WI
53207
US

V. Phone/Fax

Practice location:
  • Phone: 414-397-2953
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95155096
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number193054-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: