Provider Demographics
NPI:1154924710
Name:BROWN, TAMARA
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3137 N RICHARDT AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-6386
Mailing Address - Country:US
Mailing Address - Phone:317-428-9992
Mailing Address - Fax:
Practice Address - Street 1:3137 N RICHARDT AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-6386
Practice Address - Country:US
Practice Address - Phone:317-428-9992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No291U00000XLaboratoriesClinical Medical Laboratory