Provider Demographics
NPI:1215439161
Name:FAMILY PRACTICE VISITING PROVIDERS LLC
Entity type:Organization
Organization Name:FAMILY PRACTICE VISITING PROVIDERS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:MAIDEN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:937-248-9968
Mailing Address - Street 1:120 EAST MARKET ST. SUITE 1273
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-3250
Mailing Address - Country:US
Mailing Address - Phone:317-807-0859
Mailing Address - Fax:317-807-0862
Practice Address - Street 1:120 E MARKET ST STE 1273
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-3250
Practice Address - Country:US
Practice Address - Phone:317-807-0859
Practice Address - Fax:317-807-0862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty