Healthcare Provider Details

I. General information

NPI: 1336640903
Provider Name (Legal Business Name): TANIKA ARNOLD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19940 CONANT ST
DETROIT MI
48234-1494
US

IV. Provider business mailing address

19940 CONANT ST
DETROIT MI
48234-1494
US

V. Phone/Fax

Practice location:
  • Phone: 313-733-4528
  • Fax: 313-733-4532
Mailing address:
  • Phone: 313-733-4528
  • Fax: 313-733-4532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number4704297291
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: