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General NPI Number Information
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NPI Number | 1073906327
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Entity Type | Individual
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Provider Name | TAMMIE BURNETT
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Gender | Female
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Dates
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Enumeration Date | 03/11/2015
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 882 OAKMAN BLVD STE F
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City | DETROIT
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State | MI
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Zip | 48238-3710
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Country | US
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Telephone | 313-961-4890
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Fax |
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Provider Business Mailing Address
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Address Line | 16116 BURGESS
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City | DETROIT
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State | MI
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Zip | 48219-3844
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Country | US
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Telephone | 248-238-6892
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Fax |
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 4703111240
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704382767
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License Number State | MI
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