Individual
JENAY TATUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
560 W 168TH ST, NEW YORK, NY 10032-3917
(212) 305-4318
Mailing address
2300 W SKYLINE RD, GLENDALE, WI 53209-2176
(414) 350-9696
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
666758
NY
Other
Enumeration date
07/01/2021
Last updated
07/01/2021
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