Healthcare Provider Details

I. General information

NPI: 1073439006
Provider Name (Legal Business Name): TIFFANY EVA MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 BRADY ST
CHESANING MI
48616-1086
US

IV. Provider business mailing address

8760 GEECK RD
CHESANING MI
48616-9608
US

V. Phone/Fax

Practice location:
  • Phone: 989-845-1800
  • Fax:
Mailing address:
  • Phone: 989-274-1914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704343439
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: