Healthcare Provider Details

I. General information

NPI: 1851213599
Provider Name (Legal Business Name): MRS. TAMMERRIE ANN NOLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W 12TH ST
PERU IN
46970-1638
US

IV. Provider business mailing address

3137 SUMMIT AVE
LOGANSPORT IN
46947-2139
US

V. Phone/Fax

Practice location:
  • Phone: 317-204-3736
  • Fax:
Mailing address:
  • Phone: 317-204-3736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06007133A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: