Healthcare Provider Details

I. General information

NPI: 1538375001
Provider Name (Legal Business Name): MISS TAKEEY LAKEYSHA WIGGINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 HAWKINS POINT ROAD BLDG 28B
BALTIMORE MD
21226
US

IV. Provider business mailing address

2401 HAWKINS POINT ROAD BLDG 28B
BALTIMORE MD
21226
US

V. Phone/Fax

Practice location:
  • Phone: 410-636-7506
  • Fax: 410-636-7868
Mailing address:
  • Phone: 410-636-7506
  • Fax: 410-636-7868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: