Individual
LYNELL WIGGINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
6701 RIDGE AVE STE 1, PHILADELPHIA, PA 19128-2468
(215) 483-4179
Mailing address
6701 RIDGE AVE STE 1, PHILADELPHIA, PA 19128-2468
(215) 483-4179
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
SP022003
PA
Other
Enumeration date
09/16/2020
Last updated
07/18/2022
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