Provider Demographics
NPI:1093539611
Name:WIGGINS, ANTHONY LOREN (CHW)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:LOREN
Last Name:WIGGINS
Suffix:
Gender:M
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48216-1921
Mailing Address - Country:US
Mailing Address - Phone:313-832-3300
Mailing Address - Fax:313-832-3393
Practice Address - Street 1:1726 HOWARD ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48216-1921
Practice Address - Country:US
Practice Address - Phone:313-832-3300
Practice Address - Fax:313-832-3393
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker