Provider Demographics
NPI:1437313707
Name:WIGGINS, JAMILA WALIDA (LPN)
Entity Type:Individual
Prefix:MS
First Name:JAMILA
Middle Name:WALIDA
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 1:2260 LAKE AVE
Mailing Address - Street 2:APT 2301
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-5758
Mailing Address - Country:US
Mailing Address - Phone:585-301-2028
Mailing Address - Fax:
Practice Address - Street 1:2260 LAKE AVE
Practice Address - Street 2:APT 2301
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14612-5758
Practice Address - Country:US
Practice Address - Phone:585-301-2028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283077-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse