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Individual
DR. MITCHELL GLENN EUSTAQUIO TAN
Active
Individual
DR. MITCHELL GLENN EUSTAQUIO TAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DNP, APRN,PMHNP-BC
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041502075
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
1632233
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209031254
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
4704421713
MI
Other
Enumeration date
10/14/2024
Last updated
03/25/2025
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