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NPI Code Detail

MEDICARE: BREANNA WIGGS

MEDICARE: BREANNA WIGGS
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1740843200
Entity Type Code : Individual
Provider Name (Legal Business Name) : BREANNA WIGGS
Provider Business Mailing Address
First Line : 9405 MAST DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89117-0287
Country : US
Telephone Number : 657-789-1458
Fax Number :
Provider Business Practice Location Address
First Line : 4618 MEADOWS LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89107-2956
Country : US
Telephone Number : 702-387-2300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2019
Last Update Date : 06/29/2026

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Directions to “ BREANNA WIGGS ” Practice Location

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