Provider Demographics
NPI:1801018213
Name:WIGGAN, VICTORIA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:WIGGAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11542 219TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1162
Mailing Address - Country:US
Mailing Address - Phone:718-949-0108
Mailing Address - Fax:718-949-0108
Practice Address - Street 1:56 VIOLA DR
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-3326
Practice Address - Country:US
Practice Address - Phone:631-478-1327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023802253140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric