Individual
MS. LANETRA ANN WILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
160 S HOLLYWOOD ST, MEMPHIS, TN 38112-4801
(901) 287-7337
(901) 287-4787
Mailing address
850 POPLAR AVE BLDG 2, MEMPHIS, TN 38105-4607
(901) 287-5565
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
24667
TN
363LP0200X
Pediatric Nurse Practitioner
902467
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q053901
—
TN
Enumeration date
08/09/2018
Last updated
12/09/2019
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