Individual
TARULATA M BHAIDASNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP-C
Contact information
Practice address
2600 FERRY ST, LAFAYETTE, IN 47904-3055
(765) 448-8000
(765) 448-8058
Mailing address
2737 WARM SPRINGS RD, COLUMBUS, GA 31904
(706) 653-2255
(706) 653-2329
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71001966A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000623458
ANTHEM PROVIDER NUMBER
IN
05
—
200536390
—
IN
Enumeration date
03/28/2006
Last updated
06/24/2015
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