Individual
TANISHA LORAINE RAQUEL SEALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9548 E BRAMBLE AVE, MESA, AZ 85208-2659
(602) 679-2477
(480) 549-3916
Mailing address
9548 E BRAMBLE AVE, MESA, AZ 85208-2659
(602) 679-2477
(480) 549-3916
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
185809
—
AZ
01
—
W12955932
NON MEDICAL HOME CARE
AZ
Enumeration date
01/06/2023
Last updated
04/03/2024
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