Provider Demographics
NPI:1891057717
Name:TATUM, ALLISON C (RN)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:C
Last Name:TATUM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1752 ISLAND POINT DR
Mailing Address - Street 2:
Mailing Address - City:LAKE PROVIDENCE
Mailing Address - State:LA
Mailing Address - Zip Code:71254-5346
Mailing Address - Country:US
Mailing Address - Phone:318-559-2012
Mailing Address - Fax:318-559-3553
Practice Address - Street 1:403 2ND ST
Practice Address - Street 2:
Practice Address - City:LAKE PROVIDENCE
Practice Address - State:LA
Practice Address - Zip Code:71254-2605
Practice Address - Country:US
Practice Address - Phone:318-559-2012
Practice Address - Fax:318-559-3553
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN089128163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health