Individual
KELLY A WIGGINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN,BSN
Contact information
Practice address
3415 SE POWELL BLVD, PORTLAND, OR 97202-3371
(503) 205-4349
Mailing address
2608 GRANT ST, VANCOUVER, WA 98660-2025
(360) 770-7221
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
201040251RN
OR
Other
Enumeration date
01/30/2012
Last updated
01/30/2012
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