MEDICARE: KIRSTEN ELIZABETH TANUI

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
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1396111241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN ELIZABETH TANUI

Provider Business Mailing Address
First Line	:	2606 EASTERN AVE SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49507-3605
Country	:	US
Telephone Number	:	616-516-6407
Fax Number	:	616-303-7030

Provider Business Practice Location Address
First Line	:	2606 EASTERN AVE SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49507-3605
Country	:	US
Telephone Number	:	616-516-6407
Fax Number	:	616-303-7030

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2015
Last Update Date	:	08/14/2015

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Directions to “ KIRSTEN ELIZABETH TANUI ” Practice Location

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