Healthcare Provider Details

I. General information

NPI: 1376944371
Provider Name (Legal Business Name): TAMMY LYNN WECKERLY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMMY LYNN MARTIN

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 WELLNESS DR
MIDLAND MI
48670-2000
US

IV. Provider business mailing address

4000 WELLNESS DR
MIDLAND MI
48670-2000
US

V. Phone/Fax

Practice location:
  • Phone: 989-839-3000
  • Fax:
Mailing address:
  • Phone: 844-832-1956
  • Fax: 989-633-5241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704234470
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number104788
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: