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NPI Code Detail

MEDICARE: MS. MIRIAM KRISTEN WIGGINS PA

MEDICARE: MS. MIRIAM KRISTEN WIGGINS PA
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
1363A00000XPhysician Assistant1351MA
2363AM0700XMedical Physician Assistant1320CT

General Provider Information

NPI Number : 1194753087
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MIRIAM KRISTEN WIGGINS PA
Provider Business Mailing Address
First Line : 1290 SILAS DEANE HWY
Second Line :
City : WETHERSFIELD
State : CT
Zip : 06109-4337
Country : US
Telephone Number : 860-777-1280
Fax Number : 860-777-1276
Provider Business Practice Location Address
First Line : 385 W MAIN ST
Second Line :
City : AVON
State : CT
Zip : 06001-4357
Country : US
Telephone Number : 860-777-1280
Fax Number : 860-777-1276
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2006
Last Update Date : 10/06/2023

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