Provider Demographics
NPI:1245836790
Name:WIGGINS, SIANNI UNIQUE (RMA)
Entity type:Individual
Prefix:
First Name:SIANNI
Middle Name:UNIQUE
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:RMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4236 N CARLISLE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-1912
Mailing Address - Country:US
Mailing Address - Phone:215-300-7687
Mailing Address - Fax:
Practice Address - Street 1:4236 N CARLISLE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-1912
Practice Address - Country:US
Practice Address - Phone:215-300-7687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA7000634RMA171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider