Provider Demographics
NPI:1265665889
Name:WIGGINS, TAMMY LEE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LEE
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 THURLOW DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-2826
Mailing Address - Country:US
Mailing Address - Phone:315-510-6968
Mailing Address - Fax:
Practice Address - Street 1:119 THURLOW DR
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-2826
Practice Address - Country:US
Practice Address - Phone:315-510-6968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-30
Last Update Date:2009-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10293074164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse