MEDICARE: ANNIE DORIS WAKEFIELD

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	3747P1801X	Personal Care Attendant	1401000477	VA

General Provider Information

NPI Number	:	1871436212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIE DORIS WAKEFIELD

Provider Business Mailing Address
First Line	:	8048 SPRING THAW LN
Second Line	:
City	:	NEW KENT
State	:	VA
Zip	:	23124-3071
Country	:	US
Telephone Number	:	504-351-2040
Fax Number	:

Provider Business Practice Location Address
First Line	:	8048 SPRING THAW LN
Second Line	:
City	:	NEW KENT
State	:	VA
Zip	:	23124-3071
Country	:	US
Telephone Number	:	540-351-2040
Fax Number	:

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

Provider Enumeration Date	:	04/10/2026
Last Update Date	:	04/10/2026

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