Healthcare Provider Details

I. General information

NPI: 1215439161
Provider Name (Legal Business Name): FAMILY PRACTICE VISITING PROVIDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E MARKET ST STE 1273
INDIANAPOLIS IN
46204-3250
US

IV. Provider business mailing address

120 EAST MARKET ST. SUITE 1273
INDIANAPOLIS IN
46204-3250
US

V. Phone/Fax

Practice location:
  • Phone: 317-807-0859
  • Fax: 317-807-0862
Mailing address:
  • Phone: 317-807-0859
  • Fax: 317-807-0862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MS. TAMMIE RENA MAIDEN
Title or Position: FAMILY NURSE PRACTITIONER
Credential: FNP
Phone: 937-248-9968