Provider Demographics
NPI:1548335946
Name:TWIGGS, CHERYL
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:
Last Name:TWIGGS
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:JEFFEREY
Other - Middle Name:
Other - Last Name:TWIGGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2253 E JAEGER ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-2934
Mailing Address - Country:US
Mailing Address - Phone:480-898-8336
Mailing Address - Fax:
Practice Address - Street 1:2253 E JAEGER ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-2934
Practice Address - Country:US
Practice Address - Phone:480-898-8336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4000385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ744153OtherAHCCCS ID NUMBER