Tanya D Burk-Willson, RN
Individual provider Active NPI Registered Nurse · Dyer, IN
NPI 1285055285 · NPPES record last updated Dec 18, 2013
Key facts
- NPI
- 1285055285
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 28204517A (IN)
- Practice address
- 14600 W 81St St.
Bibich Elementary
Dyer, IN 46311 - Phone
- (219) 322-1185
- NPI assigned
- Dec 18, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28204517A | IN | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lake Central School Corporation | Past | Accepting new patients | |
| Lake Central School Corporation | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 28204517A | IN | Yes |
Addresses
Primary practice location
14600 W 81St St.
Bibich Elementary
Dyer, IN 46311
Mailing address
8260 Wicker Ave.
Lake Central School Corporation
Saint John, IN 46373
Phone (219) 365-8507
Other providers in Dyer, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 18, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.