Provider Demographics
NPI:1316439151
Name:ADAMS, TASHEIKA THIREE
Entity type:Individual
Prefix:MISS
First Name:TASHEIKA
Middle Name:THIREE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6467 N 52ND ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-6011
Mailing Address - Country:US
Mailing Address - Phone:414-899-7486
Mailing Address - Fax:414-797-4487
Practice Address - Street 1:6467 N 52ND ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-6011
Practice Address - Country:US
Practice Address - Phone:414-899-7486
Practice Address - Fax:414-797-4487
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIA3528288074707172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver