Provider Demographics
NPI:1437112844
Name:WIGGLEY, RITA LOVACIA (PA)
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:LOVACIA
Last Name:WIGGLEY
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1721 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-3401
Mailing Address - Country:US
Mailing Address - Phone:314-771-6065
Mailing Address - Fax:
Practice Address - Street 1:915 N GRAND BLVD
Practice Address - Street 2:11FJC
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-1621
Practice Address - Country:US
Practice Address - Phone:314-652-4100
Practice Address - Fax:314-289-6478
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO112061363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant