Healthcare Provider Details

I. General information

NPI: 1073906327
Provider Name (Legal Business Name): TAMMIE BURNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2015
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

882 OAKMAN BLVD STE F
DETROIT MI
48238-3710
US

IV. Provider business mailing address

16116 BURGESS
DETROIT MI
48219-3844
US

V. Phone/Fax

Practice location:
  • Phone: 313-961-4890
  • Fax:
Mailing address:
  • Phone: 248-238-6892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703111240
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704382767
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: