Individual
TANETTA C MAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, FNP
Contact information
Practice address
410 N 12TH ST, OSKALOOSA, IA 52577-2495
(641) 672-3360
Mailing address
2000 S MAIN ST, FAIRFIELD, IA 52556-9572
(641) 672-3360
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2000167490
MO
363LF0000X
Family Nurse Practitioner
A-112035
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010568509
—
MO
01
—
36800018
BCBS
—
01
—
36800048
BCBS
—
05
—
420721300
—
MO
05
—
540568508
—
MO
05
—
595956103
—
MO
05
—
595956202
—
MO
05
—
595956400
—
MO
05
—
595985805
—
MO
05
—
599225901
—
MO
Enumeration date
04/19/2006
Last updated
06/19/2019
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