Provider Demographics
NPI:1124372834
Name:WAKEMAN, MINDY (CNIM)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:WAKEMAN
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 TRAILDUST DR
Mailing Address - Street 2:
Mailing Address - City:MILLIKEN
Mailing Address - State:CO
Mailing Address - Zip Code:80543-3030
Mailing Address - Country:US
Mailing Address - Phone:970-405-0319
Mailing Address - Fax:
Practice Address - Street 1:592 TRAILDUST DR
Practice Address - Street 2:
Practice Address - City:MILLIKEN
Practice Address - State:CO
Practice Address - Zip Code:80543-3030
Practice Address - Country:US
Practice Address - Phone:970-405-0319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic