MEDICARE: MS. TANISHA RAQUEL STRELOW RDH

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	124Q00000X	Dental Hygienist	2902018703	MI

General Provider Information

NPI Number	:	1568947513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TANISHA RAQUEL STRELOW RDH

Provider Business Mailing Address
First Line	:	935 MARQUETTE AVE
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49442-1376
Country	:	US
Telephone Number	:	231-660-3888
Fax Number	:	231-737-1724

Provider Business Practice Location Address
First Line	:	2201 S GETTY ST. MUSKEGON, HEIGHTS MICHIGAN
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49444-4944
Country	:	US
Telephone Number	:	231-737-1711
Fax Number	:

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

Provider Enumeration Date	:	09/26/2018
Last Update Date	:	09/26/2018

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