Healthcare Provider Details

I. General information

NPI: 1255241923
Provider Name (Legal Business Name): TAQUELIA I SPEARS SPECIMEN COLLECTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1862 W FOND DU LAC AVE STE 9
MILWAUKEE WI
53205-1137
US

IV. Provider business mailing address

1862 W FOND DU LAC AVE STE 9
MILWAUKEE WI
53205-1137
US

V. Phone/Fax

Practice location:
  • Phone: 833-437-8436
  • Fax: 414-677-7279
Mailing address:
  • Phone: 833-437-8436
  • Fax: 414-677-7279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: