Provider Demographics
NPI:1649393612
Name:WIGGINS, RENEE (RDLD)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:RDLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9205 NEW HAMPSHIRE AVE
Mailing Address - Street 2:B-4
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-3629
Mailing Address - Country:US
Mailing Address - Phone:301-434-5461
Mailing Address - Fax:301-434-0217
Practice Address - Street 1:9205 NEW HAMPSHIRE AVE
Practice Address - Street 2:B-4
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-3629
Practice Address - Country:US
Practice Address - Phone:301-434-5461
Practice Address - Fax:301-434-0217
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD01370133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD53DIROtherCAREFIRST
DC8040-0001OtherCARE FIRST
MD2744726OtherAETNA
MD2340501OtherUHCP
MD7426290OtherAETNA
MD342892OtherMAMSI