Provider Demographics
NPI:1255834792
Name:WIGGINS, TANESHA SHERE
Entity Type:Individual
Prefix:
First Name:TANESHA
Middle Name:SHERE
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 HARRIS DR
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-3078
Mailing Address - Country:US
Mailing Address - Phone:580-470-6820
Mailing Address - Fax:
Practice Address - Street 1:2409 HARRIS DR
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-3078
Practice Address - Country:US
Practice Address - Phone:580-470-6820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator