Healthcare Provider Details

I. General information

NPI: 1063986479
Provider Name (Legal Business Name): ROSARIO TANGUAY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4136 LEGACY PKWY
LANSING MI
48911-4265
US

IV. Provider business mailing address

LIB-LEGACY LANSING -MI, MI, 4136 LEGACY PARKWAY
LANSING MI
48911
US

V. Phone/Fax

Practice location:
  • Phone: 517-492-0517
  • Fax: 517-882-3633
Mailing address:
  • Phone: 517-492-0784
  • Fax: 517-913-6267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number4704295379
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704295379
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: