Individual
TANIQUA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2626 E 46TH ST, STE J, INDIANAPOLIS, IN 46205-2380
(317) 475-9066
Mailing address
3178 N CAPITOL AVE, INDIANAPOLIS, IN 46208-4626
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
27060931A
IN
Other
Enumeration date
12/16/2008
Last updated
12/16/2008
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