Individual
JONI WIGGINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2035 MESQUITE AVE STE D, LAKE HAVASU CITY, AZ 86403-5894
(928) 505-7100
Mailing address
29116 N 250TH AVE, WITTMANN, AZ 85361-1039
(602) 620-6431
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP051949
AZ
Other
Enumeration date
01/22/2022
Last updated
01/22/2022
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