Individual
ALAINA TATUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11456 BROADWAY, CROWN POINT, IN 46307-7106
(219) 488-0154
Mailing address
11456 BROADWAY, CROWN POINT, IN 46307-7106
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110-007660
VA
363A00000X
Physician Assistant
Primary
10003859A
IN
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
02/13/2020
Last updated
03/12/2024
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