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General NPI Number Information
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NPI Number | 1447877303
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Entity Type | Individual
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Provider Name | QUIANA WILSON
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Gender | Female
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Dates
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Enumeration Date | 06/26/2020
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Last Update Date | 07/01/2020
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Provider Practice Location Address
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Address Line | 3209 ELMHURST DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46226-6221
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Country | US
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Telephone | 317-749-4321
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Fax |
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Provider Business Mailing Address
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Address Line | 3209 ELMHURST DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46226-6221
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Country | US
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Telephone | 317-749-4321
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | 180142201
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number | 180142201
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 180142201
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License Number State |
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Taxonomy #4
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 180142201
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License Number State | IN
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Taxonomy #5
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number | 180142201
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License Number State | IN
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Taxonomy #6
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 180142201
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License Number State | IN
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