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NPI Code Detail

MEDICARE: TARYN SUE PICKELL

MEDICARE:   TARYN SUE PICKELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse4704192455MI

General Provider Information

NPI Number : 1194132167
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARYN SUE PICKELL
Provider Business Mailing Address
First Line : 2601 S SAINT ANTHONY ST
Second Line :
City : JACKSON
State : MI
Zip : 49203-3712
Country : US
Telephone Number : 517-962-1832
Fax Number : 517-784-1370
Provider Business Practice Location Address
First Line : 2601 S SAINT ANTHONY ST
Second Line :
City : JACKSON
State : MI
Zip : 49203-3712
Country : US
Telephone Number : 517-962-1832
Fax Number : 517-784-1370
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2014
Last Update Date : 07/22/2014

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Directions to “ TARYN SUE PICKELL ” Practice Location

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