Individual provider · Type 1 NPI
Lanetra Ann Wiley, NP
Pediatric Nurse Practitioner · Memphis, TN
NPI number
1407335490
Active
Practice location
160 S Hollywood St
Memphis, TN 38112-4801
Fax (901) 287-4787
Mailing address
850 Poplar Ave Bldg 2
Memphis, TN 38105-4607
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Pediatric Nurse Practitioner Primary | 363LP0200X | 24667 (TN) |
| Pediatric Nurse Practitioner | 363LP0200X | 902467 (MS) |
Pediatric Nurse Practitioner: Definition to come...
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About NPI 1407335490
Lanetra Ann Wiley, NP's National Provider Identifier is 1407335490, issued on Aug 9, 2018. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in Memphis, TN. The record was last updated on Dec 9, 2019.