Healthcare Provider Details

I. General information

NPI: 1902352297
Provider Name (Legal Business Name): TENZIN TSEPEL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N EAST AVE
JACKSON MI
49201-1753
US

IV. Provider business mailing address

2015 FAIR STREET
ANN ARBOR MI
48103
US

V. Phone/Fax

Practice location:
  • Phone: 248-892-0715
  • Fax:
Mailing address:
  • Phone: 734-272-5166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704283753
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: