Healthcare Provider Details

I. General information

NPI: 1740928423
Provider Name (Legal Business Name): TIARA PEOPLES NSHR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: N/A N/A N/A NSHR

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2447 E 65TH ST
INDIANAPOLIS IN
46220-1503
US

IV. Provider business mailing address

2447 E 65TH ST
INDIANAPOLIS IN
46220-1503
US

V. Phone/Fax

Practice location:
  • Phone: 317-699-9338
  • Fax:
Mailing address:
  • Phone: 317-699-9338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: