Healthcare Provider Details

I. General information

NPI: 1275143703
Provider Name (Legal Business Name): TAMEKA MAYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 11/27/2023
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5727 WINDSOR AVE
PHILADELPHIA PA
19143-5232
US

IV. Provider business mailing address

5314 CHANCELLOR ST
PHILADELPHIA PA
19139-4048
US

V. Phone/Fax

Practice location:
  • Phone: 267-239-3808
  • Fax:
Mailing address:
  • Phone: 267-239-3808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN561739
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: