Provider Demographics
NPI:1750563169
Name:WIGGANS, TERESA ANN (RN, FNP)
Entity type:Individual
Prefix:MS
First Name:TERESA
Middle Name:ANN
Last Name:WIGGANS
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-5707
Mailing Address - Country:US
Mailing Address - Phone:765-935-7284
Mailing Address - Fax:
Practice Address - Street 1:1901 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-5707
Practice Address - Country:US
Practice Address - Phone:765-935-7284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC097054363LF0000X
IN71004935B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily