Individual
TAMISHA TAVOLACCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2766 11 MILE RD, BERKLEY, MI 48072-3033
(248) 542-2424
Mailing address
33315 VISTA WAY, FRASER, MI 48026-4324
(586) 260-4056
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704306069
MI
Other
Enumeration date
08/28/2015
Last updated
08/28/2015
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