Provider Demographics
NPI:1184644296
Name:BIELE, TAMMY J (NP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:J
Last Name:BIELE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1515 S 19TH ST
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-2941
Practice Address - Country:US
Practice Address - Phone:765-552-7346
Practice Address - Fax:765-552-3351
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000904A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01014106OtherRR MEDICARE PTAN
IN200366930Medicaid
IN200366930Medicaid
IN214510FMedicare PIN