Provider Demographics
NPI:1306302591
Name:WIGGINS, ROSALIND SUSAN (RN)
Entity type:Individual
Prefix:
First Name:ROSALIND
Middle Name:SUSAN
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ROSALIND
Other - Middle Name:SUSAN
Other - Last Name:MCNEIL-WIGGINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4323 PALO VERDE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-2948
Mailing Address - Country:US
Mailing Address - Phone:310-920-8422
Mailing Address - Fax:
Practice Address - Street 1:4323 PALO VERDE AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-2948
Practice Address - Country:US
Practice Address - Phone:310-920-8422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429563163WN0002X, 163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care