Individual
THERESA TANIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7220 CRYSTAL STONE DR SE, CALEDONIA, MI 49316-7742
(616) 427-0589
Mailing address
7220 CRYSTAL STONE DR SE, CALEDONIA, MI 49316-7742
(616) 427-0589
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703092378
MI
Other
Enumeration date
03/27/2026
Last updated
03/27/2026
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