MEDICARE: MRS. JEAN TASHINA TANIS

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	:	1740655901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEAN TASHINA TANIS

Provider Business Mailing Address
First Line	:	35425 W MICHIGAN AVE
Second Line	:
City	:	WAYNE
State	:	MI
Zip	:	48184-9800
Country	:	US
Telephone Number	:	734-467-7600
Fax Number	:	734-467-7636

Provider Business Practice Location Address
First Line	:	2944 FULLER AVE NE
Second Line	:	SUITE 301
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-3784
Country	:	US
Telephone Number	:	616-284-5871
Fax Number	:	616-774-1001

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

Provider Enumeration Date	:	12/14/2015
Last Update Date	:	11/08/2024

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