Healthcare Provider Details

I. General information

NPI: 1609155480
Provider Name (Legal Business Name): TAKEISHA LATRICE ZEIGLER REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22525 E 8 MILE RD
SAINT CLAIR SHORES MI
48080-2433
US

IV. Provider business mailing address

22525 E 8 MILE RD
SAINT CLAIR SHORES MI
48080-2433
US

V. Phone/Fax

Practice location:
  • Phone: 754-207-5634
  • Fax:
Mailing address:
  • Phone: 754-207-5634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number5188499
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number4704317210
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: