Healthcare Provider Details

I. General information

NPI: 1841853223
Provider Name (Legal Business Name): TAMARA YVETTE SPENCE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMARA YVETTE SMITH NURSE PRACTITIONER

II. Dates (important events)

Enumeration Date: 04/21/2019
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6050 GREENFIELD RD STE 101
DEARBORN MI
48126-6004
US

IV. Provider business mailing address

43072 N CUMBERLAND DR
VAN BUREN TWP MI
48111-2385
US

V. Phone/Fax

Practice location:
  • Phone: 313-945-9000
  • Fax: 313-945-7500
Mailing address:
  • Phone: 248-747-2210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number4704260806
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704260806
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: