Individual
ALLISON MARIE TANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1040 WISHARD BLVD, INDIANAPOLIS, IN 46202-2872
(317) 962-8893
(317) 962-5479
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71008199A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068010450
MEDICARE PTAN
IN
01
—
264430H49
MEDICARE PTAN
IN
05
—
300017604
—
IN
Enumeration date
08/14/2018
Last updated
08/15/2023
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