Provider Demographics
NPI:1306452636
Name:WIGGINS, PAMELA W
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:W
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 645
Mailing Address - Street 2:
Mailing Address - City:AYNOR
Mailing Address - State:SC
Mailing Address - Zip Code:29511-0645
Mailing Address - Country:US
Mailing Address - Phone:184-335-8200
Mailing Address - Fax:843-358-2007
Practice Address - Street 1:242 8TH AVE
Practice Address - Street 2:
Practice Address - City:AYNOR
Practice Address - State:SC
Practice Address - Zip Code:29511-3222
Practice Address - Country:US
Practice Address - Phone:843-358-2005
Practice Address - Fax:843-358-2007
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCIHCP-0128374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty