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Individual

TANILLE LEANA LOUIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS, PHMNP-BC

Contact information

Practice address
1200 RESERVOIR AVE, CRANSTON, RI 02920-6012
(401) 919-0406
Mailing address
425 LAKE AVE N, WORCESTER, MA 01605-2072
(401) 919-0406

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
APRN01719
RI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN2298328
MA

Other

Enumeration date
12/01/2016
Last updated
07/13/2021
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