Individual
TAMMY LYNN MOHR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3584 FAIRLANES AVE SW STE 2, GRANDVILLE, MI 49418-1583
(616) 222-5300
Mailing address
3584 FAIRLANES AVE SW STE 2, GRANDVILLE, MI 49418-1583
(616) 222-5300
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
305391
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M6008126391902
DRIVERS LICENSE
WI
Enumeration date
02/15/2022
Last updated
02/15/2022
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