Provider Demographics
NPI:1245206986
Name:WIGGINS, VIRGINIA L (PA)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:L
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLAIN
Mailing Address - State:WI
Mailing Address - Zip Code:53577-9668
Mailing Address - Country:US
Mailing Address - Phone:608-546-4211
Mailing Address - Fax:
Practice Address - Street 1:825 MAIN ST
Practice Address - Street 2:
Practice Address - City:PLAIN
Practice Address - State:WI
Practice Address - Zip Code:53577-9668
Practice Address - Country:US
Practice Address - Phone:608-546-4211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI712363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1245206986Medicaid
002115430Medicare PIN
WI543400542Medicare PIN
WI065074150Medicare PIN
WI42938100Medicaid
R39575Medicare UPIN