Individual
TALISHA T WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9165 OTIS AVE STE 110, INDIANAPOLIS, IN 46216-2307
(317) 657-9116
Mailing address
9165 OTIS AVE STE 110, INDIANAPOLIS, IN 46216-2307
(317) 657-9116
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
1550684500
IN
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
04/16/2020
Last updated
11/15/2022
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