Provider Demographics
NPI:1326427659
Name:WIGAND, FARRAH (RDN, LD, CSOWM)
Entity Type:Individual
Prefix:
First Name:FARRAH
Middle Name:
Last Name:WIGAND
Suffix:
Gender:F
Credentials:RDN, LD, CSOWM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 ROYAL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-8237
Mailing Address - Country:US
Mailing Address - Phone:502-438-6041
Mailing Address - Fax:803-520-7638
Practice Address - Street 1:140 ROYAL CREEK DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-8237
Practice Address - Country:US
Practice Address - Phone:803-814-4218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-19
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC164133V00000X
932508133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered