Provider Demographics
NPI:1447130372
Name:GOUARD-WEST, THOMIKA LETIA (RN BSN)
Entity type:Individual
Prefix:
First Name:THOMIKA
Middle Name:LETIA
Last Name:GOUARD-WEST
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 JULIAN AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-3755
Mailing Address - Country:US
Mailing Address - Phone:317-693-5560
Mailing Address - Fax:
Practice Address - Street 1:4900 JULIAN AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46201-3755
Practice Address - Country:US
Practice Address - Phone:317-693-5560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28254729A163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Single Specialty