Provider Demographics
NPI:1194616680
Name:DULLEN, TAUHIDAH (LPN)
Entity type:Individual
Prefix:
First Name:TAUHIDAH
Middle Name:
Last Name:DULLEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 BOULEVARD PL
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-5622
Mailing Address - Country:US
Mailing Address - Phone:317-734-4347
Mailing Address - Fax:
Practice Address - Street 1:2540 BOULEVARD PL
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-5622
Practice Address - Country:US
Practice Address - Phone:317-734-4347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27077718A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse