Provider Demographics
NPI:1639302292
Name:DUNCAN, TAWYANA MONIQUE
Entity type:Individual
Prefix:
First Name:TAWYANA
Middle Name:MONIQUE
Last Name:DUNCAN
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 1:2461 W BROWN ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53205-1013
Mailing Address - Country:US
Mailing Address - Phone:414-873-5367
Mailing Address - Fax:414-873-5367
Practice Address - Street 1:2461 W BROWN ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-1013
Practice Address - Country:US
Practice Address - Phone:414-873-5367
Practice Address - Fax:414-873-5367
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI148306-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse