Provider Demographics
NPI:1902140981
Name:WIGGINS, ALICIA-ANN DANIELLE (LPN)
Entity Type:Individual
Prefix:
First Name:ALICIA-ANN
Middle Name:DANIELLE
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 MONTFORD RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2078
Mailing Address - Country:US
Mailing Address - Phone:216-414-8602
Mailing Address - Fax:
Practice Address - Street 1:942 MONTFORD RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44121-2078
Practice Address - Country:US
Practice Address - Phone:216-414-8602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH144320164W00000X
332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
No164W00000XNursing Service ProvidersLicensed Practical Nurse