Wiley, Lanetra Ann

Wiley, Lanetra Ann is an individual health care provider with primary practice located at 160 S Hollywood St , Memphis TN 38112-4801. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Wiley, Lanetra Ann can be contacted via phone (901) 287-7337.

Contact Information

Primary practice address
160 S Hollywood St Memphis TN 38112-4801
Phone: (901) 287-7337
Fax: (901) 287-4787
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 24667 Tennessee
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 902467 Mississippi

Profile Details

NPI number 1407335490
LBN Legal business name Wiley, Lanetra Ann
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 9th, 2018
Last updated Dec 9th, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407335490 NPPES
Tennessee MEDICAID Q053901

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