Individual
TATTIYONA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3841 VAN NESS AVE, NORTH LAS VEGAS, NV 89081-4062
(562) 391-3981
Mailing address
3841 VAN NESS AVE, NORTH LAS VEGAS, NV 89081-4062
(562) 391-3981
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00001935159
—
NV
Enumeration date
10/25/2015
Last updated
10/25/2015
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