Healthcare Provider Details

I. General information

NPI: 1730841271
Provider Name (Legal Business Name): TAWANDA LEFLORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1928 45TH ST
MUNSTER IN
46321-3917
US

IV. Provider business mailing address

10167 SENTRY DR
SAINT JOHN IN
46373-8662
US

V. Phone/Fax

Practice location:
  • Phone: 219-476-7246
  • Fax:
Mailing address:
  • Phone: 708-264-6371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number041363505
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71012047A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: