Provider Demographics
NPI:1902858590
Name:DWIGGINS, KAREN BOGGS (CRNA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:BOGGS
Last Name:DWIGGINS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:4120 MEADOWRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-8144
Mailing Address - Country:US
Mailing Address - Phone:704-340-4408
Mailing Address - Fax:
Practice Address - Street 1:4120 MEADOWRIDGE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8144
Practice Address - Country:US
Practice Address - Phone:704-340-4408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC070068367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8051315Medicaid
SCNAN604Medicaid
SCNAN604Medicaid
NC2610520Medicare PIN