MEDICARE: LAURA 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	367500000X	Certified Registered Nurse Anesthetist	RN500267L	PA

General Provider Information

NPI Number	:	1972591113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA WIGGINS

Provider Business Mailing Address
First Line	:	1120 RURAL RIDGE DR
Second Line	:	SUITE 200, CWING
City	:	CHESWICK
State	:	PA
Zip	:	15024-2438
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9100 BABCOCK BLVD
Second Line	:	SUITE 200, CWING
City	:	PITTSBURGH
State	:	PA
Zip	:	15237-5815
Country	:	US
Telephone Number	:	412-748-6719
Fax Number	:

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	05/24/2021

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