Wallace T. Wiggam, RN

Primary specialty

Addiction (Substance Use Disorder) Registered NurseTaxonomy code 163WA0400X

License

307469 Issued in CA

Practice address

2403 Professional Dr # Ca
Santa Rosa, CA 95403-3007

Phone

(707) 544-3295

NPI assigned

Jan 16, 2020

Last updated

Jan 16, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Drug Abuse Alternatives Center

  dba Center Point DAAC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Santa Rosa, CA
  • NPI 1629856430
  NPD
• Drug Abuse Alternatives Center

  • Addiction (Substance Use Disorder) Counselor
  • Santa Rosa, CA
  • NPI 1063064715
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1579132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579132800000",
    "number": "1932739141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2403 PROFESSIONAL DR # CA",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954033007",
            "telephone_number": "707-544-3295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2403 PROFESSIONAL DR # CA",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954033007",
            "telephone_number": "707-544-3295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIGGAM",
        "first_name": "WALLACE",
        "middle_name": "T.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-01-16",
        "last_updated": "2020-01-16",
        "certification_date": "2020-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "307469",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret Wideau
• Derek Widener, PTA
• Jennifer Widerhorn
• Ellie Rivkah Pritschet Wiener
• Makayla Danielle Wietek
• Katharine Wignall, RN
• Wilber & Associates
• Heather Wilber
• Richard Wilber, MD
• Frank Ray Wilbur, D.C.

• Addiction (Substance Use Disorder) Registered Nurse in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Addiction (Substance Use Disorder) Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.