Provider Demographics
NPI:1952914608
Name:NASH-WALLS, TAMEKIA R
Entity Type:Individual
Prefix:MRS
First Name:TAMEKIA
Middle Name:R
Last Name:NASH-WALLS
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 1:6766 MORTON TAYLOR ROAD
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-1156
Mailing Address - Country:US
Mailing Address - Phone:734-474-6203
Mailing Address - Fax:
Practice Address - Street 1:6766 MORTON TAYLOR RD
Practice Address - Street 2:
Practice Address - City:VAN BUREN TWP
Practice Address - State:MI
Practice Address - Zip Code:48111-1156
Practice Address - Country:US
Practice Address - Phone:734-474-6203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704312078163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse