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NPI Code Detail

MEDICARE: TASIA WILSON

MEDICARE: TASIA WILSON
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1467796029
Entity Type Code : Individual
Provider Name (Legal Business Name) : TASIA WILSON
Provider Business Mailing Address
First Line : 3153 E WARM SPRINGS RD
Second Line : #200
City : LAS VEGAS
State : NV
Zip : 89120-3141
Country : US
Telephone Number : 702-586-7409
Fax Number : 702-586-7530
Provider Business Practice Location Address
First Line : 3153 E WARM SPRINGS RD
Second Line : #200
City : LAS VEGAS
State : NV
Zip : 89120-3141
Country : US
Telephone Number : 702-586-7409
Fax Number : 702-586-7530
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2012
Last Update Date : 11/20/2012

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Directions to “ TASIA WILSON ” Practice Location

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