Healthcare Provider Details

I. General information

NPI: 1902603178
Provider Name (Legal Business Name): TANISHA ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11117 RACINE RD
WARREN MI
48093-6563
US

IV. Provider business mailing address

11117 RACINE RD
WARREN MI
48093-6563
US

V. Phone/Fax

Practice location:
  • Phone: 313-353-3917
  • Fax:
Mailing address:
  • Phone: 313-353-3917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number20250000268
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: