Individual
MRS. TAMARA L RIESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
525 W BRISTOL ST, ELKHART, IN 46514-2964
(574) 262-0239
(574) 262-8391
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-3725
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
71006906A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
167490001
MEDICARE PTAN
IN
01
—
169380073
MEDICARE PTAN
IN
01
—
236040211
MEDICARE PTAN
IN
05
—
300001317
—
IN
05
—
300129298
—
IN
01
—
MI7204009
MEDICARE PTAN
IN
Enumeration date
03/29/2006
Last updated
04/28/2026
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