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General NPI Number Information
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NPI Number | 1518615962
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Entity Type | Individual
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Provider Name | TANESHA MAE MCWILLIAMS NP
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Gender | Female
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Dates
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Enumeration Date | 03/15/2022
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Last Update Date | 03/15/2022
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Provider Practice Location Address
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Address Line | 1201 N POST RD STE 4
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4225
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Country | US
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Telephone | 317-405-8833
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Fax |
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Provider Business Mailing Address
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Address Line | 10585 CORDIFF CT
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City | NOBLESVILLE
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State | IN
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Zip | 46060-4896
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Country | US
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Telephone | 317-250-6696
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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 | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | 71012351A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 71012351A
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License Number State | IN
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