Provider Demographics
NPI:1669052379
Name:WIGGINS, JEROLNASHIA TYFERO
Entity type:Individual
Prefix:
First Name:JEROLNASHIA
Middle Name:TYFERO
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 1:1997 WOLOSYN CIR APT 4
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44514-1356
Mailing Address - Country:US
Mailing Address - Phone:234-237-6947
Mailing Address - Fax:
Practice Address - Street 1:1997 WOLOSYN CIR APT 4
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-1356
Practice Address - Country:US
Practice Address - Phone:234-237-6947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide