Individual
MEREDITH MADER TATARZYCKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
530 S JACKSON ST, LOUISVILLE, KY 40202-1675
(502) 852-5851
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0330
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
209900
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
3012692
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300020101
—
IN
01
—
3012692
LICENSE
KY
05
—
7100557470
—
KY
01
—
K235880
MEDICARE
KY
Enumeration date
07/09/2018
Last updated
11/30/2018
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