Individual
TARA LEE NIMTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
400 TEEGARDEN ST, LA PORTE, IN 46350-3175
(219) 326-0043
(219) 326-8909
Mailing address
400 TEEGARDEN ST, LA PORTE, IN 46350-3175
(219) 326-0043
(219) 326-8909
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
28155899A
IN
363L00000X
Nurse Practitioner
Primary
71010414A
IN
Other
Enumeration date
08/10/2020
Last updated
02/12/2024
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