Individual
TYNISE LA'SHAIE PENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
29877 TELEGRAPH RD STE 401, SOUTHFIELD, MI 48034-7661
(248) 294-0539
(248) 934-1390
Mailing address
31355 BRETZ DR, WARREN, MI 48093-5532
(313) 350-1657
(248) 934-1390
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704240129
MI
363LA2200X
Adult Health Nurse Practitioner
4704240129
MI
Other
Enumeration date
12/03/2009
Last updated
02/28/2024
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