MEDICARE: THOMIKA LETIA GOUARD-WEST RN BSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	28254729A	IN

General Provider Information

NPI Number	:	1447130372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMIKA LETIA GOUARD-WEST RN BSN

Provider Business Mailing Address
First Line	:	4900 JULIAN AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-3755
Country	:	US
Telephone Number	:	317-693-5560
Fax Number	:

Provider Business Practice Location Address
First Line	:	4900 JULIAN AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-3755
Country	:	US
Telephone Number	:	317-693-5560
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2025
Last Update Date	:	09/03/2025

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