Provider Demographics
NPI:1538375001
Name:WIGGINS, TAKEEY LAKEYSHA
Entity type:Individual
Prefix:MISS
First Name:TAKEEY
Middle Name:LAKEYSHA
Last Name:WIGGINS
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 1:2401 HAWKINS POINT ROAD
Mailing Address - Street 2:BLDG 28B
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21226
Mailing Address - Country:US
Mailing Address - Phone:410-636-7506
Mailing Address - Fax:410-636-7868
Practice Address - Street 1:2401 HAWKINS POINT ROAD
Practice Address - Street 2:BLDG 28B
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21226
Practice Address - Country:US
Practice Address - Phone:410-636-7506
Practice Address - Fax:410-636-7868
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist