Individual
LESLEE A TATUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1701 N SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(888) 484-3258
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
28164251A
IN
363LA2100X
Acute Care Nurse Practitioner
Primary
71004032A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000806999
ANTHEM PTAN
IN
01
—
000000844568
ANTHEM PTAN
IN
01
—
000000864048
ANTHEM PTAN
IN
01
—
000001341106
ANTHEM PTAN
IN
01
—
1102230356
ANTHEM PTAN
IN
05
—
201135070
—
IN
01
—
Q00013262
RAILROAD PTAN
IN
Enumeration date
06/12/2012
Last updated
02/18/2025
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