Provider Demographics
NPI:1922541465
Name:LOUIS, TANILLE LEANA (MS, PHMNP-BC)
Entity Type:Individual
Prefix:
First Name:TANILLE
Middle Name:LEANA
Last Name:LOUIS
Suffix:
Gender:F
Credentials:MS, PHMNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 LAKE AVE N
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2072
Mailing Address - Country:US
Mailing Address - Phone:401-919-0406
Mailing Address - Fax:
Practice Address - Street 1:1200 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6012
Practice Address - Country:US
Practice Address - Phone:401-919-0406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN01719363LP0808X
MARN2298328363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health