Individual
MRS. TYWANNA R TANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
1158 FORT ST, LINCOLN PARK, MI 48146-1840
(313) 989-0124
Mailing address
PO BOX 1448, LINCOLN PARK, MI 48146-7248
(313) 974-9487
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
—
—
363L00000X
Nurse Practitioner
Primary
4704264238
MI
Other
Enumeration date
12/06/2018
Last updated
09/01/2021
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