Individual
TARA JO DEKAMP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
7999 FOLKS RD, HANOVER, MI 49241-9784
(517) 250-0800
Mailing address
7999 FOLKS RD, HANOVER, MI 49241-9784
(517) 250-0800
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
4704304674
MI
Other
Enumeration date
09/01/2021
Last updated
06/22/2022
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