Healthcare Provider Details

I. General information

NPI: 1912057654
Provider Name (Legal Business Name): TAMMY JUSTICE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16155 PETZ RD
MUSSEY MI
48014-1605
US

IV. Provider business mailing address

220 W 4TH ST
IMLAY CITY MI
48444-1045
US

V. Phone/Fax

Practice location:
  • Phone: 810-388-1200
  • Fax:
Mailing address:
  • Phone: 810-388-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: