Individual provider · Type 1 NPI

Tyiesha Wilson

Clinical Laboratory Director (Non-physician) · Chicago, IL

NPI number 1891455168 Active

Practice location

2800 W Lake St
Chicago, IL 60612-1908

Call (773) 999-6071 Map

Mailing address

1440 W Taylor St # 1105
Chicago, IL 60607-4623

Specialties and licenses

TaxonomyCodeLicense
Clinical Laboratory Director (Non-physician) Primary 247ZC0005XNone listed

Clinical Laboratory Director (Non-physician): An individual who is state-licensed as a clinical laboratory director and meets the qualifications in the Clinical Laboratory Improvement Amendments of 1988 for non-physicians (non-MD/DO) as defined in the CFR 42 Part 493.1405.

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About NPI 1891455168

Tyiesha Wilson's National Provider Identifier is 1891455168, issued on Dec 28, 2021. The primary taxonomy on file is Clinical Laboratory Director (Non-physician) (247ZC0005X), and the practice location is in Chicago, IL. The record was last updated on Dec 28, 2021.