Provider Demographics
NPI:1740928423
Name:PEOPLES, TIARA (NSHR)
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:
Last Name:PEOPLES
Suffix:
Gender:F
Credentials:NSHR
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NSHR
Mailing Address - Street 1:2447 E 65TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1503
Mailing Address - Country:US
Mailing Address - Phone:317-699-9338
Mailing Address - Fax:
Practice Address - Street 1:2447 E 65TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-1503
Practice Address - Country:US
Practice Address - Phone:317-699-9338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN85-1790190OtherIRS.GOV