Healthcare Provider Details

I. General information

NPI: 1043304967
Provider Name (Legal Business Name): TAMYRA HENIGAN CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

573 N BRADLEY HWY
ROGERS CITY MI
49779-1508
US

IV. Provider business mailing address

573 N BRADLEY HWY
ROGERS CITY MI
49779-1508
US

V. Phone/Fax

Practice location:
  • Phone: 989-734-2171
  • Fax: 989-734-2312
Mailing address:
  • Phone: 989-734-2171
  • Fax: 989-734-2312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704171541
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: