Individual
SANDRA TIETEMIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
955 W BROADWAY AVE, MUSKEGON, MI 49441-3521
(231) 755-0637
(231) 755-6208
Mailing address
2851 MONOLITH DR, HUDSONVILLE, MI 49426-7652
(231) 755-0637
(231) 755-6208
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703085335
MI
Other
Enumeration date
07/22/2013
Last updated
07/22/2013
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