Active NPI
Tatum Nicole Rose
- Emergency Registered Nurse
- South Bend, IN
National Provider Identifier
1811865587
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Registered Nurse
- License
- 28254591A
- Practice address
- 615 N Michigan St
South Bend, IN 46601-1033 - Phone
- (574) 647-7459
- NPI assigned
- Oct 25, 2025
- Last updated
- Oct 25, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Registered Nurse | 163WE0003X | 28254591A | IN | Primary |
Addresses
Primary practice location
615 N Michigan St
South Bend, IN 46601-1033
Mailing address
1319 Emerald Dr
Niles, MI 49120-4524
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28254591A | IN | MD | Emergency Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1761350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1761350400000",
"number": "1811865587",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1319 EMERALD DR",
"city": "NILES",
"state": "MI",
"postal_code": "491204524"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "615 N MICHIGAN ST",
"city": "SOUTH BEND",
"state": "IN",
"postal_code": "466011033",
"telephone_number": "574-647-7459"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSE",
"first_name": "TATUM",
"middle_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-10-25",
"last_updated": "2025-10-25",
"certification_date": "2025-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "163WE0003X",
"taxonomy_group": "",
"desc": "Registered Nurse, Emergency",
"state": "IN",
"license": "28254591A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Bend, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.