Provider Demographics
NPI:1780567941
Name:WIGEN, LUAN SARAH (MASSMA70020873)
Entity type:Individual
Prefix:
First Name:LUAN
Middle Name:SARAH
Last Name:WIGEN
Suffix:
Gender:F
Credentials:MASSMA70020873
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 N MULLAN RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4333
Mailing Address - Country:US
Mailing Address - Phone:509-688-4297
Mailing Address - Fax:
Practice Address - Street 1:1420 N MULLAN RD STE 104
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4333
Practice Address - Country:US
Practice Address - Phone:509-688-4297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMASS.MA.70020873225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist