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Individual

MRS. TAMARA LYNN WYSCAVER DIRVEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ACNP-BC

Contact information

Practice address
3990 JOHN R ST, DETROIT, MI 48201-2018
(313) 993-6023
Mailing address
PO BOX 1524, AUGUSTA, GA 30903-1524
(706) 774-8326
(706) 774-7230

Taxonomy

Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
4704193954
MI
363LA2100X
Acute Care Nurse Practitioner
RN287474
GA

Other

Enumeration date
05/25/2012
Last updated
04/03/2024
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