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NPI Code Detail

MEDICARE: LAMYJA WANTESE JERNIGAN

MEDICARE: LAMYJA WANTESE JERNIGAN
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1720939226
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAMYJA WANTESE JERNIGAN
Provider Business Mailing Address
First Line : 27250 TREMAINE DR APT 205-05
Second Line :
City : EUCLID
State : OH
Zip : 44132-3455
Country : US
Telephone Number : 440-255-1700
Fax Number :
Provider Business Practice Location Address
First Line : 9220 MENTOR AVE
Second Line :
City : MENTOR
State : OH
Zip : 44060-6412
Country : US
Telephone Number : 440-255-1700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2026
Last Update Date : 02/09/2026

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Directions to “ LAMYJA WANTESE JERNIGAN ” Practice Location

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