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General NPI Number Information
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NPI Number | 1225286347
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Entity Type | Individual
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Provider Name | CRAIG TATOM APN
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Gender | Male
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 09/03/2008
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Provider Practice Location Address
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Address Line | HWY 72 N PHYSICIANS OFFICE BUILDING II
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City | SALEM
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State | MO
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Zip | 65560
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Country | US
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Telephone | 573-729-6112
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Fax | 573-729-4035
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Provider Business Mailing Address
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Address Line | PO BOX 69
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City | SALEM
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State | MO
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Zip | 65560-0069
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Country | US
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Telephone | 573-729-6112
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Fax | 573-729-4035
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 128312
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License Number State | MO
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