Individual
TINA MARIE PLOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
109 W SOUTH AVE, HOUGHTON, MI 49931-2242
(906) 370-2770
Mailing address
109 W SOUTH AVE, HOUGHTON, MI 49931-2242
(906) 370-2770
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704293205
MI
363L00000X
Nurse Practitioner
Primary
4704293205
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704293205
REGISTERED NURSE
MI
Enumeration date
09/17/2019
Last updated
09/17/2019
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