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General NPI Number Information
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NPI Number | 1215439161
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Entity Type | Organization
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Legal Business Name | FAMILY PRACTICE VISITING PROVIDERS LLC
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Dates
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Enumeration Date | 03/07/2018
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Last Update Date | 03/07/2018
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Provider Practice Location Address
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Address Line | 120 E MARKET ST STE 1273
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-3250
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Country | US
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Telephone | 317-807-0859
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Fax | 317-807-0862
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Provider Business Mailing Address
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Address Line | 120 EAST MARKET ST. SUITE 1273
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City | INDIANAPOLIS
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State | IN
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Zip | 46204-3250
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Country | US
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Telephone | 317-807-0859
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Fax | 317-807-0862
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MS. TAMMIE RENA MAIDEN
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Credential | FNP
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Telephone | 937-248-9968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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