Individual
TAMMY RENEE BACKEN
Active
Individual
TAMMY RENEE BACKEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MEDICAL ASSISTANT
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
E5Z6Y6E3
IN
363A00000X
Physician Assistant
E5Z6Y6E3
IN
Other
Enumeration date
02/02/2023
Last updated
02/06/2023
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