Provider Demographics
NPI:1528661428
Name:STEELE, ANTALEKA Q (BA)
Entity type:Individual
Prefix:
First Name:ANTALEKA
Middle Name:Q
Last Name:STEELE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 WIGWAM PKWY APT 1824
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-2875
Mailing Address - Country:US
Mailing Address - Phone:702-510-7868
Mailing Address - Fax:
Practice Address - Street 1:2925 WIGWAM PKWY APT 1824
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-2875
Practice Address - Country:US
Practice Address - Phone:702-510-7868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV171W00000XMedicaid