Most Relevant Information
Provider Data
| NPI Number: | 1003435322 |
| Provider Name: | TALISHA T WILSON |
| Entity Type: | Individual |
| Taxonomy Code: | 172A00000X |
| Specialty: | Driver |
| License Number: | 1550684500 |
Most Important Dates
| Enumeration Date: | 04/16/2020 |
| Last Updated: | 11/15/2022 |
Provider Practice Location
9165 OTIS AVE STE 110
INDIANAPOLIS
IN
462162307
Practice Location Phone/Fax
| Phone: | 3176579116 |
| Fax: |
Provider Mailing Location
9165 OTIS AVE STE 110
INDIANAPOLIS
IN
462162307
Provider Mailing Phone/Fax
| Phone: | 3176579116 |
| Fax: |