Individual
TAMMIE RENA MAIDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
3266 N MERIDIAN ST, INDIANAPOLIS, IN 46208
(317) 925-0653
Mailing address
117 W SUNRISE AVE, DAYTON, OH 45426-3527
(937) 248-9968
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71007687A
IN
363LP2300X
Primary Care Nurse Practitioner
Primary
71007687A
IN
Other
Enumeration date
07/24/2007
Last updated
09/06/2018
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