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General NPI Number Information
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NPI Number | 1063986479
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Entity Type | Individual
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Provider Name | ROSARIO TANGUAY PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/18/2019
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 4136 LEGACY PKWY
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City | LANSING
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State | MI
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Zip | 48911-4265
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Country | US
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Telephone | 517-492-0517
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Fax | 517-882-3633
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Provider Business Mailing Address
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Address Line | LIB-LEGACY LANSING -MI, MI, 4136 LEGACY PARKWAY
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City | LANSING
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State | MI
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Zip | 48911
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Country | US
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Telephone | 517-492-0784
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Fax | 517-913-6267
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 4704295379
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704295379
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License Number State | MI
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