WALLACE T. WIGGAM (NPI# 1932739141) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932739141 |
| Entity Type | Individual |
| Full Name | WALLACE T. WIGGAM |
| Credential | RN |
| Practice Address |
2403 Professional Dr # Ca Santa Rosa CA 95403-3007 |
| Practice Telephone | 7075443295 |
| Mailing Telephone | 7075443295 |
| Enumeration Date | 2020-01-16 |
| Last Update Date | 2020-01-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WA0400X |
Registered Nurse Specialization: Addiction (Substance Use Disorder) |
307469 | CA | Nursing Service Providers |
| Street Address |
2403 PROFESSIONAL DR # CA |
| City | SANTA ROSA |
| State | CA |
| Zip Code | 95403-3007 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912549841 | Abundance Acupuncture Healing Clinic | Acupuncturist | 3410 Mendocino Avenue, Santa Rosa, CA 95403 | 2019-10-11 |
| 1982161337 | Crystal J Ward | Registered Nurse | 2350 Mendocino Ave, Ste A4, Santa Rosa, CA 95403 | 2019-02-21 |
| 1033674379 | George Edward Griese | Respiratory Therapist, Registered | 501 Bicentennial Way, Santa Rosa, CA 95403 | 2019-01-31 |
| 1508320672 | East-west Natural Medicine Inc. | Acupuncturist | 2200 Range Ave #207, Santa Rosa, CA 95403 | 2019-01-23 |
| 1316410640 | Lionel C Cooper | Counselor | 315 Mark West Springs Road, Santa Rosa, CA 95403 | 2019-01-09 |
| 1326519182 | Jkb Solutions Inc. | In Home Supportive Care | 3554 Round Barn Boulevard, Suite 311, Santa Rosa, CA 95403 | 2018-12-05 |
| 1487121265 | Catholic Charities of The Diocese of Santa Rosa | Clinic/Center | 987 Airway Ct, Santa Rosa, CA 95403 | 2018-10-30 |
| 1447746524 | Lisa Jean Quang | Optometrist | 3925 Old Redwood, Medical Office Building 4, Suite 141, Santa Rosa, CA 95403 | 2018-07-02 |
| 1598253353 | Jennifer Renee Lummus | Community Health Worker | 3614 Condo Court, Santa Rosa, CA 95403 | 2018-04-27 |
| 1871042366 | Sadie Thuet | Marriage & Family Therapist | 3434 A Mendocino Ave, Santa Rosa, CA 95403 | 2016-09-26 |
| Find all providers in zip 95403 | ||||
| Taxonomy Code | 163WA0400X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568899532 | Tema Hlynn Pacheco | Registered Nurse | 1901 Cleveland Avenue #b, Santa Rosa Treatment Program, Santa Rosa, CA 95401 | 2013-10-04 |
| 1205181005 | Jessica Sickler Schmidt | Registered Nurse | 480 Tesconi Cir Ste B, Santa Rosa, CA 95401-4691 | 2012-07-17 |
| 1912277450 | Leana Jordan | Registered Nurse | 1901 Cleveland Ave Ste B, Santa Rosa, CA 95401-4298 | 2011-12-30 |
| 1962796292 | Michael E Peters | Registered Nurse | 3333 Chanate Rd, Santa Rosa, CA 95404-1707 | 2011-06-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467075549 | Tracy Eileen Erickson | Registered Nurse | 8950 Cal Center Dr Ste 160, Sacramento, CA 95826-3225 | 2020-05-22 |
| 1942837232 | Joe Charles Filipi | Registered Nurse | 29 Rowan Dr, Aliso Viejo, CA 92656-4280 | 2020-03-25 |
| 1144785254 | Vincent Falcone | Registered Nurse | 6715 W Wren Ave, Visalia, CA 93291-8344 | 2019-02-02 |
| 1427544642 | Tamekia Latesica Brown | Registered Nurse | 9418 Wareham Dr, Bakersfield, CA 93313-5816 | 2018-07-11 |
| 1942701313 | Beatrix Dozier | Registered Nurse | 293 N State College Blvd Apt 2061, Orange, CA 92868-5715 | 2018-02-21 |
| 1326564147 | Continued Care Nursing Services Inc. | Registered Nurse | 45741 Shadow Mountain Dr, Palm Desert, CA 92260-4624 | 2017-08-15 |
| 1265989727 | Nurses for Safe Access | Registered Nurse | 27209 Highway 189, Blue Jay, CA 92317 | 2016-09-01 |
| 1265883250 | Kelley Hoffman | Registered Nurse | 148 W Avenida San Antonio, San Clemente, CA 92672-4354 | 2016-06-30 |
| 1215396114 | Richard Perlstein | Registered Nurse | 23524 Daisetta Dr, Newhall, CA 91321-3721 | 2016-02-19 |
| 1942694138 | Deidre Fitzpatrick | Registered Nurse | 3151 Airway Ave Ste D1, Costa Mesa, CA 92626-4622 | 2015-03-25 |
| Find all providers with the same taxonomy | ||||
| City | SANTA ROSA |
| Zip Code | 95403 |
Please comment or provide details below to improve the information on WALLACE T. WIGGAM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.