Healthcare Provider Details

I. General information

NPI: 1669343638
Provider Name (Legal Business Name): TAMMIA SYNTYCHE WHEELER ASN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 10/24/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 JOHN R ST
DETROIT MI
48201-1916
US

IV. Provider business mailing address

38815 EQUESTRIAN S APT 44201
FARMINGTON HILLS MI
48331-4934
US

V. Phone/Fax

Practice location:
  • Phone: 313-576-1000
  • Fax:
Mailing address:
  • Phone: 248-974-1016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number4704353284
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: