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General NPI Number Information
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NPI Number | 1891567905
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Entity Type | Individual
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Provider Name | TAMALA NDENGUMA PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/23/2023
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Last Update Date | 02/02/2025
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Provider Practice Location Address
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Address Line | 2010 N CAPITOL AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-1222
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Country | US
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Telephone | 214-436-2893
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Fax |
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Provider Business Mailing Address
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Address Line | 7272 WURZBACH RD STE 601
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City | SAN ANTONIO
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State | TX
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Zip | 78240-4803
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Country | US
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Telephone | 214-436-2893
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 28221320A
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License Number State | IN
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