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Individual

TATYANA TENENBOYM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
50 STANIFORD STREET, C/O MA ANESTHESIA CORP, BOSTON, MA 02114
(248) 423-5100
Mailing address
P.O. BOX 372, C/O MA ANESTHESIA CORP, STOUGHTON, MA 02072-0372
(781) 341-3966
(781) 341-8269

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2265689
MA
367500000X
Certified Registered Nurse Anesthetist
4704205247
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
104783761
MI
01
TT205247
BLUE CROSS OF MI
MI
Enumeration date
07/30/2006
Last updated
11/14/2011
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