Provider Demographics
NPI:1740843275
Name:MILLER, TAKEYA D (ADMINSTER)
Entity type:Individual
Prefix:
First Name:TAKEYA
Middle Name:D
Last Name:MILLER
Suffix:
Gender:F
Credentials:ADMINSTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E 25TH ST STE 2E
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5304
Mailing Address - Country:US
Mailing Address - Phone:240-360-8784
Mailing Address - Fax:443-453-9132
Practice Address - Street 1:420 E 25TH ST STE 2E
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5304
Practice Address - Country:US
Practice Address - Phone:240-360-8784
Practice Address - Fax:443-453-9132
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR4454P374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide