Healthcare Provider Details

I. General information

NPI: 1861057176
Provider Name (Legal Business Name): TIFFANY RADER MSN RN AGCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N SENATE AVE
INDIANAPOLIS IN
46202-5306
US

IV. Provider business mailing address

8270 E COUNTY ROAD 300 N
BROWNSBURG IN
46112-9385
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-2376
  • Fax:
Mailing address:
  • Phone: 317-402-8912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number28187282A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: