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General NPI Number Information
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NPI Number | 1346858529
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Entity Type | Individual
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Provider Name | LISA GILBERT WIGINGTON
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Gender | Female
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Dates
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Enumeration Date | 07/14/2020
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Last Update Date | 07/14/2020
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Provider Practice Location Address
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Address Line | 516 E NIZHONI BLVD
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City | GALLUP
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State | NM
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Zip | 87301-5748
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Country | US
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Telephone | 505-722-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 204 WEST ST
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City | BATESVILLE
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State | MS
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Zip | 38606-1534
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Country | US
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Telephone | 662-832-0543
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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 | 163WM0102X
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Taxonomy Name | Maternal Newborn Registered Nurse
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License Number | R728152
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License Number State | MS
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