Organization
PROVISIONS HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON WIGGINS D.O. (PHYSICIAN)
(517) 346-7628
Entity
Organization
Contact information
Practice address
2522 GOLF RD STE 2, EAU CLAIRE, WI 54701-6033
(715) 833-0660
Mailing address
9557 S AIRPORT RD, DEWITT, MI 48820-9104
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
5101013727
MI
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22-76363
MEDICAL LICENSE
WI
Enumeration date
08/05/2006
Last updated
12/11/2022
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