Individual
PAULINA TACKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
39363 OWENDALE DR, STERLING HEIGHTS, MI 48310-2569
(586) 883-2905
Mailing address
4640 SIDNEY ST, SHELBY TOWNSHIP, MI 48317-2955
(586) 883-2905
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704338150
MI
367500000X
Certified Registered Nurse Anesthetist
Primary
4704338150
MI
Other
Enumeration date
07/09/2021
Last updated
11/20/2023
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