MEDICARE: TAMARA INDERLIED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	4703085833	MI

General Provider Information

NPI Number	:	1487027223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA INDERLIED

Provider Business Mailing Address
First Line	:	10450 6 MILE RD LOT 240
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49014-9551
Country	:	US
Telephone Number	:	269-419-2050
Fax Number	:

Provider Business Practice Location Address
First Line	:	10450 6 MILE RD LOT 240
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49014-9551
Country	:	US
Telephone Number	:	269-419-2050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2015
Last Update Date	:	11/02/2015

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Directions to “ TAMARA INDERLIED ” Practice Location

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