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General NPI Number Information
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NPI Number | 1962154740
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Entity Type | Individual
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Provider Name | JONI WIGGINS
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Gender | Female
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Dates
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Enumeration Date | 01/22/2022
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Last Update Date | 01/22/2022
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Provider Practice Location Address
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Address Line | 2035 MESQUITE AVE STE D
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5894
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Country | US
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Telephone | 928-505-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 29116 N 250TH AVE
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City | WITTMANN
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State | AZ
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Zip | 85361-1039
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Country | US
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Telephone | 602-620-6431
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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 | LP051949
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License Number State | AZ
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