=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538750831
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TANYA DRINKALL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2021
-----------------------------------------------------
Last Update Date | 01/29/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 116 W MITCHELL ST
-----------------------------------------------------
City | PETOSKEY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49770-2357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-348-2828
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 890 INTERTOWN RD
-----------------------------------------------------
City | PETOSKEY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49770-9502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-347-6056
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 4704231020
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------