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Individual

SALLY-ANN TAMIZUDDIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN

Contact information

Practice address
2200 LAKE VICTORIA DR, SPRINGFIELD, IL 62703-5596
(217) 529-9266
Mailing address
1778 CHATHAM RD, SPRINGFIELD, IL 62704-3202
(217) 891-1587

Taxonomy

Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
041.413811
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
277004034
IL

Other

Enumeration date
05/23/2022
Last updated
04/25/2025
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