Individual
HEATHER TACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
15474 HAGGERTY RD, NORTHVILLE, MI 48170-0844
(248) 615-0889
(734) 404-5317
Mailing address
901 MCCLINTOCK DR, SUITE 202, BURR RIDGE, IL 60527-0844
(888) 220-6432
(630) 734-4715
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704222690
MI
Other
Enumeration date
05/17/2011
Last updated
04/19/2013
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