Individual
TISA SALAHUD-DIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2121 LAKE AVENUE, FORT WAYNE, IN 46805-5100
(260) 426-5431
(260) 421-1092
Mailing address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
(260) 421-1092
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
28175839A
IN
Other
Enumeration date
03/01/2023
Last updated
03/01/2023
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