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General NPI Number Information
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NPI Number | 1700398666
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Entity Type | Individual
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Provider Name | TABATHA D LANDRUM NP
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Gender | Female
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Dates
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Enumeration Date | 11/01/2017
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 1205 HADLEY RD STE 120
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City | MOORESVILLE
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State | IN
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Zip | 46158-1934
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Country | US
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Telephone | 317-528-2555
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Fax | 317-528-2566
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Provider Business Mailing Address
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Address Line | PO BOX 781076
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City | DETROIT
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State | MI
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Zip | 48278-1008
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Country | US
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Telephone | 317-528-4800
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Fax | 317-865-1479
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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 | 71009930A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 28186169A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71009930A
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License Number State | IN
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