Individual
TYLER CLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1105 6TH ST, TRAVERSE CITY, MI 49684-2345
(231) 935-5000
Mailing address
1105 6TH ST, TRAVERSE CITY, MI 49684-2345
(231) 935-7690
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704339380
MI
Other
Enumeration date
12/19/2022
Last updated
12/19/2022
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