Healthcare Provider Details

I. General information

NPI: 1366869976
Provider Name (Legal Business Name): PEGGY WIGGINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 W HIGHWAY 76
MARION SC
29571-6621
US

IV. Provider business mailing address

1629 W HIGHWAY 76
MARION SC
29571-6621
US

V. Phone/Fax

Practice location:
  • Phone: 843-423-6733
  • Fax:
Mailing address:
  • Phone: 843-423-6733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number24837
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: