1255241923 NPI number — TAQUELIA I SPEARS SPECIMEN COLLECTOR

Table of content: TAQUELIA I SPEARS SPECIMEN COLLECTOR (NPI 1255241923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255241923 NPI number — TAQUELIA I SPEARS SPECIMEN COLLECTOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPEARS
Provider First Name:
TAQUELIA
Provider Middle Name:
I
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SPECIMEN COLLECTOR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255241923
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1862 W FOND DU LAC AVE STE 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53205-1137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
833-437-8436
Provider Business Mailing Address Fax Number:
414-677-7279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1862 W FOND DU LAC AVE STE 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53205-1137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-437-8436
Provider Business Practice Location Address Fax Number:
414-677-7279
Provider Enumeration Date:
09/08/2026

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 246RP1900X , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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