MEDICARE: TATTIYONA 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
1	146D00000X	Personal Emergency Response Attendant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881066207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATTIYONA WILSON

Provider Business Mailing Address
First Line	:	3841 VAN NESS AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-4062
Country	:	US
Telephone Number	:	562-391-3981
Fax Number	:

Provider Business Practice Location Address
First Line	:	3841 VAN NESS AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-4062
Country	:	US
Telephone Number	:	562-391-3981
Fax Number	:

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

Provider Enumeration Date	:	10/25/2015
Last Update Date	:	10/25/2015

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Directions to “ TATTIYONA WILSON ” Practice Location

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