Provider Demographics
NPI:1104325018
Name:RIGGS, NANCY DIANA (PCA)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:DIANA
Last Name:RIGGS
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CARROW LN
Mailing Address - Street 2:
Mailing Address - City:JULIAN
Mailing Address - State:WV
Mailing Address - Zip Code:25529-9574
Mailing Address - Country:US
Mailing Address - Phone:304-369-3583
Mailing Address - Fax:
Practice Address - Street 1:100 CARROW LN
Practice Address - Street 2:
Practice Address - City:JULIAN
Practice Address - State:WV
Practice Address - Zip Code:25529-9574
Practice Address - Country:US
Practice Address - Phone:304-369-3583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVNA3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5269043000OtherPROVIDER ID