Provider Demographics
NPI:1386392108
Name:WIGG, ROMONA ALANE
Entity type:Individual
Prefix:
First Name:ROMONA
Middle Name:ALANE
Last Name:WIGG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2895 MENDENHALL LOOP RD SPC 68
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7417
Mailing Address - Country:US
Mailing Address - Phone:907-209-6860
Mailing Address - Fax:
Practice Address - Street 1:2895 MENDENHALL LOOP RD SPC 68
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7417
Practice Address - Country:US
Practice Address - Phone:907-209-6860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK0721014347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle