Provider Demographics
NPI:1053321935
Name:WIGGINS, GEORGE E (CRNA)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:E
Last Name:WIGGINS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12266 DEER RUN RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-8948
Mailing Address - Country:US
Mailing Address - Phone:618-525-1649
Mailing Address - Fax:
Practice Address - Street 1:12266 DEER RUN RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-8948
Practice Address - Country:US
Practice Address - Phone:618-964-1223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1075328/1932A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered