Healthcare Provider Details

I. General information

NPI: 1285020750
Provider Name (Legal Business Name): WILHEMINA TAMEKA JOHNSON-WIGGINS RN, MSN, APN, C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WILHEMINA MARTIN

II. Dates (important events)

Enumeration Date: 04/12/2015
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505A WHITE HORSE PIKE
ATCO NJ
08004-2438
US

IV. Provider business mailing address

505A WHITE HORSE PIKE
ATCO NJ
08004-2438
US

V. Phone/Fax

Practice location:
  • Phone: 856-210-0079
  • Fax: 856-210-1958
Mailing address:
  • Phone: 856-210-0790
  • Fax: 856-210-1958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ00016500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number26NJ0016500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: