MEDICARE: MS. JENNIFER D TIGGS LABOR DOULA

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		MI

General Provider Information

NPI Number	:	1013797323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER D TIGGS LABOR DOULA

Provider Business Mailing Address
First Line	:	4072 W PHILADELPHIA ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48204-2447
Country	:	US
Telephone Number	:	313-918-8018
Fax Number	:

Provider Business Practice Location Address
First Line	:	4072 W PHILADELPHIA ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48204-2447
Country	:	US
Telephone Number	:	313-918-8018
Fax Number	:

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

Provider Enumeration Date	:	10/03/2023
Last Update Date	:	10/03/2023

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