Individual
JACKIE WIGGINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRT
Contact information
Practice address
15000 POTOMAC TOWN PL, WOODBRIDGE, VA 22191-6586
(678) 237-6150
Mailing address
15000 POTOMAC TOWN PL, WOODBRIDGE, VA 22191-6586
(678) 237-6150
Taxonomy
Speciality
Code
Description
License number
State
2278H0200X
Home Health Certified Respiratory Therapist
Primary
0117007960
VA
251E00000X
Home Health Agency
1401181619
VA
Other
Enumeration date
03/16/2017
Last updated
03/16/2017
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