Individual
WALLACE T. WIGGAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
2403 PROFESSIONAL DR # CA, SANTA ROSA, CA 95403-3007
(707) 544-3295
Mailing address
2403 PROFESSIONAL DR # CA, SANTA ROSA, CA 95403-3007
(707) 544-3295
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
307469
CA
Other
Enumeration date
01/16/2020
Last updated
01/16/2020
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