Provider Demographics
NPI:1609155480
Name:ZEIGLER, TAKEISHA LATRICE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:TAKEISHA
Middle Name:LATRICE
Last Name:ZEIGLER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22525 E 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2433
Mailing Address - Country:US
Mailing Address - Phone:754-207-5634
Mailing Address - Fax:
Practice Address - Street 1:22525 E 8 MILE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2433
Practice Address - Country:US
Practice Address - Phone:754-207-5634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5188499164W00000X
MI4704317210163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No164W00000XNursing Service ProvidersLicensed Practical Nurse