Provider Demographics
NPI:1114254257
Name:WIGGINS, TAMECOK TERESE (LPN)
Entity Type:Individual
Prefix:MS
First Name:TAMECOK
Middle Name:TERESE
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1779 TREMAINSVILLE RD APT 232
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-4030
Mailing Address - Country:US
Mailing Address - Phone:419-944-6272
Mailing Address - Fax:
Practice Address - Street 1:1779 TREMAINSVILLE RD APT 232
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-4030
Practice Address - Country:US
Practice Address - Phone:419-944-6272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH122471164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse