Provider Demographics
NPI:1831493840
Name:TATUM, JEROME ANTHONY (RN)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:ANTHONY
Last Name:TATUM
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 PHILIP ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70113-2525
Mailing Address - Country:US
Mailing Address - Phone:504-620-5045
Mailing Address - Fax:504-568-6647
Practice Address - Street 1:2221 PHILIP ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70113-2525
Practice Address - Country:US
Practice Address - Phone:504-620-5045
Practice Address - Fax:504-568-6647
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA081771163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse