Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | 01064302 | IN |
NPI | 1639380769 |
---|---|
Provider Name | Dr. Stacey Elaine Tarvin |
First Address | Indianapolis, IN 46206-1026 |
Second Address | Indianapolis, IN 46202-5119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 19/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201035650 | (05) | IN |