Provider Demographics
NPI:1376219162
Name:WIGGINS, RHONDA LAVETTE
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:LAVETTE
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 JOHNSTON AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-4502
Mailing Address - Country:US
Mailing Address - Phone:201-205-4589
Mailing Address - Fax:
Practice Address - Street 1:63A 8TH ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5056
Practice Address - Country:US
Practice Address - Phone:201-541-8600
Practice Address - Fax:201-541-8600
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program