Provider Demographics
NPI:1508488131
Name:WIGLEY, ANITA D
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:D
Last Name:WIGLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MAIN ROAD
Mailing Address - Street 2:
Mailing Address - City:RUSSIAN MISSION
Mailing Address - State:AK
Mailing Address - Zip Code:99657
Mailing Address - Country:US
Mailing Address - Phone:907-584-5611
Mailing Address - Fax:907-584-5830
Practice Address - Street 1:1 MAIN ROAD
Practice Address - Street 2:
Practice Address - City:RUSSIAN MISSION
Practice Address - State:AK
Practice Address - Zip Code:99657
Practice Address - Country:US
Practice Address - Phone:907-584-5611
Practice Address - Fax:907-584-5830
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker