Doctor Name: | DR. TANYA BOLDENOW |
NPI Number: | 1083837173 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 4301099387 |
Business Practice Address: | 5301 E Huron River Dr Ypsilanti, MI - 481971051 |
Business Phone Number: | 7347123935 |
Business Fax Number: | |
Mailing Address: | 5301 E Huron River Dr, YPSILANTI |
State: | MI |
Postal Code: | 481971051 |
Phone Number: | 7347123935 |
Fax Number: | |
NPI Enumeration Date: | 04/10/2007 |
NPI Last Update Date: | 05/11/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 4301099387 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MI |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |