Provider Demographics
NPI:1508809641
Name:WIGGS, ROBERTA L (ARNP)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:L
Last Name:WIGGS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:L
Other - Last Name:BOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1510
Mailing Address - Country:US
Mailing Address - Phone:509-838-4651
Mailing Address - Fax:509-363-2762
Practice Address - Street 1:107 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1510
Practice Address - Country:US
Practice Address - Phone:509-838-4651
Practice Address - Fax:509-363-2762
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00056994163W00000X
IDN29293163W00000X
IDNP472A363L00000X
WAAP30001972363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA150139OtherDEPT. OF L & I
WA9625674Medicaid
MW0154928OtherDEA
WA150139OtherDEPT. OF L & I