Healthcare Provider Details

I. General information

NPI: 1477801249
Provider Name (Legal Business Name): TAMMY J CARON RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 08/27/2012
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

4523 SPINNAKER LN
PLEASANT LAKE MI
49272-9624
US

V. Phone/Fax

Practice location:
  • Phone: 517-416-7800
  • Fax:
Mailing address:
  • Phone: 517-416-7545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number4704160347
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: