Provider Demographics
NPI:1609185404
Name:TRACK, LAKEISHA RENEE
Entity Type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:RENEE
Last Name:TRACK
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 1:616 PINEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-8012
Mailing Address - Country:US
Mailing Address - Phone:419-514-7821
Mailing Address - Fax:
Practice Address - Street 1:616 PINEWOOD AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-8012
Practice Address - Country:US
Practice Address - Phone:419-514-7821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide