Healthcare Provider Details

I. General information

NPI: 1821414889
Provider Name (Legal Business Name): CHRIS LYNN WIGGS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 ONTARIO ST.
OSHKOSH WI
54901
US

IV. Provider business mailing address

2150 ONTARIO ST
OSHKOSH WI
54901-1837
US

V. Phone/Fax

Practice location:
  • Phone: 920-216-1796
  • Fax:
Mailing address:
  • Phone: 920-216-1796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number117702-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: