MEDICARE: TAMARIA MARIMBA WHITE RN

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	163WH0200X	Home Health Registered Nurse	4704337438	MI
2	163W00000X	Registered Nurse	4704337438	MI

General Provider Information

NPI Number	:	1396500518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARIA MARIMBA WHITE RN

Provider Business Mailing Address
First Line	:	25675 W HILLS DR
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-1054
Country	:	US
Telephone Number	:	580-318-1344
Fax Number	:

Provider Business Practice Location Address
First Line	:	25675 W HILLS DR
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-1054
Country	:	US
Telephone Number	:	580-318-1344
Fax Number	:

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

Provider Enumeration Date	:	02/16/2024
Last Update Date	:	02/16/2024

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