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NPI Code Detail

MEDICARE: QUEELA TADOUM NP

MEDICARE: QUEELA TADOUM NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1364SP0808XPsychiatric/Mental Health Clinical Nurse Specialist28156253AIN

General Provider Information

NPI Number : 1598427809
Entity Type Code : Individual
Provider Name (Legal Business Name) : QUEELA TADOUM NP
Provider Business Mailing Address
First Line : 5602 CAITO DRIVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46226-1346
Country : US
Telephone Number : 317-544-4390
Fax Number : 317-544-4350
Provider Business Practice Location Address
First Line : 5602 CAITO DRIVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46226-1346
Country : US
Telephone Number : 317-544-4390
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2021
Last Update Date : 10/13/2021

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