Provider Demographics
NPI:1336524149
Name:WIGGINS, TERRELL O'NEAL
Entity Type:Individual
Prefix:MR
First Name:TERRELL
Middle Name:O'NEAL
Last Name:WIGGINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 JUSTIN CT
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-9123
Mailing Address - Country:US
Mailing Address - Phone:757-582-4323
Mailing Address - Fax:
Practice Address - Street 1:203 JUSTIN CT
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-9123
Practice Address - Country:US
Practice Address - Phone:757-582-4323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide