Provider Demographics
NPI:1982211637
Name:WILES, LAKEIA (CCMA/CPT/EKG/CNA)
Entity Type:Individual
Prefix:MS
First Name:LAKEIA
Middle Name:
Last Name:WILES
Suffix:
Gender:F
Credentials:CCMA/CPT/EKG/CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 RIDLEY ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19138-3104
Mailing Address - Country:US
Mailing Address - Phone:302-390-8065
Mailing Address - Fax:
Practice Address - Street 1:17327 HARBESON RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968-2832
Practice Address - Country:US
Practice Address - Phone:302-390-8065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-27
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2017603348251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health