Healthcare Provider Details

I. General information

NPI: 1548171804
Provider Name (Legal Business Name): TAMARA HOUSE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2591 S LEATON RD
MT PLEASANT MI
48858-8421
US

IV. Provider business mailing address

2591 S LEATON RD
MT PLEASANT MI
48858-8421
US

V. Phone/Fax

Practice location:
  • Phone: 989-775-4612
  • Fax: 989-775-4659
Mailing address:
  • Phone: 989-775-4612
  • Fax: 989-775-4659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704158611
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: