Provider Demographics
NPI:1437759792
Name:TAKU, PAULINE ANNE
Entity type:Individual
Prefix:
First Name:PAULINE ANNE
Middle Name:
Last Name:TAKU
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 1:200 FORT MEADE RD APT 708
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4428
Mailing Address - Country:US
Mailing Address - Phone:443-704-6448
Mailing Address - Fax:
Practice Address - Street 1:200 FORT MEADE RD APT 708
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4428
Practice Address - Country:US
Practice Address - Phone:443-704-6448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00186090376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide