Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | NV |
NPI | 1053880062 |
---|---|
Provider Name | Ms. Tyaysha Wilkerson |
First Address | Las Vegas, NV 89122-6039 |
Second Address | Las Vegas, NV 89122-6039 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2018 |
Last Update Date | 27/03/2021 |