Provider Demographics
NPI:1598576829
Name:WIGFIELD, RAEGAN L (RMA/STNA)
Entity type:Individual
Prefix:MRS
First Name:RAEGAN
Middle Name:L
Last Name:WIGFIELD
Suffix:
Gender:F
Credentials:RMA/STNA
Other - Prefix:MRS
Other - First Name:RAEGAN
Other - Middle Name:L
Other - Last Name:WIGFIELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RMA/STNA
Mailing Address - Street 1:111 HOSTETTER PL SW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44647-6273
Mailing Address - Country:US
Mailing Address - Phone:330-407-7636
Mailing Address - Fax:
Practice Address - Street 1:111 HOSTETTER PL SW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44647-6273
Practice Address - Country:US
Practice Address - Phone:330-407-6267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH602909041024251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health