=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730576612
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VIRGINIA RIGGS APN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2015
-----------------------------------------------------
Last Update Date | 04/19/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1114 GOFFLE RD
-----------------------------------------------------
City | HAWTHORNE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07506-2014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-427-7676
-----------------------------------------------------
Fax | 973-427-7676
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 254 BERGEN BLVD
-----------------------------------------------------
City | WOODLAND PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07424-2502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-256-6968
-----------------------------------------------------
Fax | 973-256-6968
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 26NN07257200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------