Individual
SAMANTHA L TIELKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1800 N CAPITOL AVE, NP E-140, INDIANAPOLIS, IN 46202-1218
(317) 962-2894
(317) 963-5285
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
71002256
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201123630
—
IN
Enumeration date
10/25/2006
Last updated
02/25/2014
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