Individual
CAROL IRENE TENEYCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
230 MICHIGAN ST NE, SUITE 230, GRAND RAPIDS, MI 49503-2550
(616) 774-2822
(616) 391-8665
Mailing address
100 MICHIGAN ST NE, MC 845, GRAND RAPIDS, MI 49503-2560
(616) 774-2822
(616) 391-8665
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704119230
MI
363L00000X
Nurse Practitioner
4704119230
MI
364SM0705X
Medical-Surgical Clinical Nurse Specialist
Primary
4704119230
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4984741
—
MI
01
—
500D111930 / 876270
BCBSM
MI
Enumeration date
03/06/2007
Last updated
10/29/2013
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