Individual
THERESE TANSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
47601 GRAND RIVER AVE, NOVI, MI 48374-1233
(248) 465-4100
Mailing address
46236 BARRINGTON RD, PLYMOUTH, MI 48170-3503
(734) 776-1071
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704263809
MI
367500000X
Certified Registered Nurse Anesthetist
561897
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002420002
—
TX
05
—
002420004
—
TX
01
—
561897
RN LICENSE
TX
01
—
P00145819
MEDICARE RAILROAD
—
Enumeration date
02/15/2006
Last updated
03/08/2019
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