Individual
MICHELE L TANZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1723 BROADWAY ST, SUITE 220, CAPE GIRARDEAU, MO 63701-4566
(573) 331-7910
(573) 331-7919
Mailing address
1723 BROADWAY ST, SUITE 220, CAPE GIRARDEAU, MO 63701-4566
(573) 331-7910
(573) 331-7919
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2010028011
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2010028011
MO LICENSE
MO
Enumeration date
08/16/2010
Last updated
08/16/2010
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