Doctor Name: | MICHELE L TANZ |
NPI Number: | 1013222983 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 2010028011 |
Business Practice Address: | 1723 Broadway St Suite 220 Cape Girardeau, MO - 637014566 |
Business Phone Number: | 5733317910 |
Business Fax Number: | 5733317919 |
Mailing Address: | 1723 Broadway St, Suite 220 CAPE GIRARDEAU |
State: | MO |
Postal Code: | 637014566 |
Phone Number: | 5733317910 |
Fax Number: | 5733317919 |
NPI Enumeration Date: | 08/16/2010 |
NPI Last Update Date: | 08/16/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 2010028011 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |