Provider Demographics
NPI:1144997370
Name:WIGGINS, ADRINE SHANICE (IBCLC)
Entity type:Individual
Prefix:
First Name:ADRINE
Middle Name:SHANICE
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 415 BOX 6006
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09114-0061
Mailing Address - Country:US
Mailing Address - Phone:336-558-5197
Mailing Address - Fax:
Practice Address - Street 1:3949 VALLEY CT UNIT F
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4335
Practice Address - Country:US
Practice Address - Phone:336-558-5197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN