Healthcare Provider Details

I. General information

NPI: 1306077367
Provider Name (Legal Business Name): TAMRA CAPRICE MOTLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35457 DOVE TRL
WESTLAND MI
48185-9100
US

IV. Provider business mailing address

35457 DOVE TRL
WESTLAND MI
48185-9100
US

V. Phone/Fax

Practice location:
  • Phone: 313-459-3563
  • Fax: 734-629-8313
Mailing address:
  • Phone: 313-459-3563
  • Fax: 734-629-8313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704250935
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: