Provider Demographics
NPI:1366869976
Name:WIGGINS, PEGGY (RN)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 W HIGHWAY 76
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-6621
Mailing Address - Country:US
Mailing Address - Phone:843-423-6733
Mailing Address - Fax:
Practice Address - Street 1:1629 W HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571-6621
Practice Address - Country:US
Practice Address - Phone:843-423-6733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24837163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health