Provider Demographics
NPI:1295814499
Name:WIGGINS, WENNIFER D (NP)
Entity Type:Individual
Prefix:
First Name:WENNIFER
Middle Name:D
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-5505
Mailing Address - Country:US
Mailing Address - Phone:410-837-2050
Mailing Address - Fax:866-629-0091
Practice Address - Street 1:5500 KNOLL NORTH DR STE 370
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2393
Practice Address - Country:US
Practice Address - Phone:410-837-2050
Practice Address - Fax:866-629-0091
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1006636363LF0000X
MDR128496363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC037337200Medicaid
MD412982201Medicaid