MEDICARE: JASMINE WIGFALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula	6597726176	MD

General Provider Information

NPI Number	:	1700606886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE WIGFALL

Provider Business Mailing Address
First Line	:	5908 CENTER DR
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-2306
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5908 CENTER DR
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-2306
Country	:	US
Telephone Number	:	202-809-5247
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2024
Last Update Date	:	10/14/2024

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Directions to “ JASMINE WIGFALL ” Practice Location

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