Provider Demographics
NPI:1568078582
Name:WIGGINS, LYNELL (CRNP)
Entity Type:Individual
Prefix:
First Name:LYNELL
Middle Name:
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6701 RIDGE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2468
Mailing Address - Country:US
Mailing Address - Phone:215-483-4179
Mailing Address - Fax:
Practice Address - Street 1:6701 RIDGE AVE STE 1
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-2468
Practice Address - Country:US
Practice Address - Phone:215-483-4179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022003363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily