Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 31258 | WI |
NPI | 1114988623 |
---|---|
Provider Name | Lora L Wiggins |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2006 |
Last Update Date | 10/04/2009 |