| Doctor Name: | DR. CAROLYN TIEPPO |
| NPI Number: | 1831444157 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DNP, CPNP-PC |
| License Number: | 4704202039 |
| Business Practice Address: | 23050 West Rd Suite 110 Brownstown Twp, MI - 481831472 |
| Business Phone Number: | 7346719800 |
| Business Fax Number: | 7346717690 |
| Mailing Address: | 23050 West Rd, Suite 110 BROWNSTOWN TWP |
| State: | MI |
| Postal Code: | 481831472 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/24/2012 |
| NPI Last Update Date: | 10/16/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 4704202039 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |