Individual
TANYA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
1050 FULTON AVE STE 235, SACRAMENTO, CA 95825-4299
(916) 614-9539
(916) 614-9542
Mailing address
1050 FULTON AVE STE 235, SACRAMENTO, CA 95825-4299
(916) 614-9539
(916) 614-9542
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
VN687200
CA
Other
Enumeration date
02/28/2022
Last updated
02/28/2022
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