Provider Demographics
NPI:1326753104
Name:WIGGINS, BRATIENA
Entity Type:Individual
Prefix:
First Name:BRATIENA
Middle Name:
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 1:34 DAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-6401
Mailing Address - Country:US
Mailing Address - Phone:937-270-8457
Mailing Address - Fax:
Practice Address - Street 1:1129 MIAMISBURG CENTERVILLE RD STE 201
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45449-4052
Practice Address - Country:US
Practice Address - Phone:937-866-4021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator