MEDICARE: MS. ADA MAE WIGGINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		NC

General Provider Information

NPI Number	:	1104107333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ADA MAE WIGGINS

Provider Business Mailing Address
First Line	:	310 7TH AVE E
Second Line	:
City	:	HENDERSONVILLE
State	:	NC
Zip	:	28792-3706
Country	:	US
Telephone Number	:	828-692-5329
Fax Number	:	828-692-1258

Provider Business Practice Location Address
First Line	:	310 7TH AVE E
Second Line	:
City	:	HENDERSONVILLE
State	:	NC
Zip	:	28792-3706
Country	:	US
Telephone Number	:	828-692-5329
Fax Number	:	828-692-1258

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2011
Last Update Date	:	09/01/2011

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