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General NPI Number Information
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NPI Number | 1134584733
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Entity Type | Individual
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Provider Name | LEA J WYGANT LPN
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Gender | Female
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Dates
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Enumeration Date | 12/23/2015
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 40 AIRPORT RD
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City | WATERVILLE
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State | ME
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Zip | 04901-4524
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Country | US
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Telephone | 207-742-8381
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Fax |
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Provider Business Mailing Address
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Address Line | 15 WINCHESTER ST APT 2
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City | FAIRFIELD
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State | ME
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Zip | 04937-1314
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Country | US
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Telephone | 207-509-8763
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LPN14196
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License Number State | ME
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