Provider Demographics
NPI:1225711831
Name:HORSLEY, TIANIQUA LESHAY
Entity Type:Individual
Prefix:
First Name:TIANIQUA
Middle Name:LESHAY
Last Name:HORSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 NE 160TH AVE APT 41
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-5498
Mailing Address - Country:US
Mailing Address - Phone:503-501-7065
Mailing Address - Fax:
Practice Address - Street 1:414 NE 160TH AVE APT 41
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-5498
Practice Address - Country:US
Practice Address - Phone:503-501-7065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No253Z00000XAgenciesIn Home Supportive Care
No374U00000XNursing Service Related ProvidersHome Health Aide