Individual
TAMARA HEASTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
900 PEELER ST STE B, KALAMAZOO, MI 49008-2380
(269) 345-8618
(269) 345-1508
Mailing address
900 PEELER ST STE B, KALAMAZOO, MI 49008-2380
(269) 345-8618
(269) 345-1508
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704140469
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07796964
—
CO
01
—
4704140469
MI LICENSE
MI
Enumeration date
09/30/2006
Last updated
01/29/2020
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