# NICOLE RENEE TANTIPITHAM

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1417266339
- **Gender:** F
- **Credential:** CRNA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LC0200X | Critical Care Medicine (Anesthesiology) Physician | 4704253054 | MI | Yes |
| 367500000X | Certified Registered Nurse Anesthetist | 4704253054 | MI | — |

## Other

- **Enumeration date:** 09/27/2010
- **Last updated:** 10/03/2019